Malawi 2015-16

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4.3 Age at First Marriage ......................................................................................................... 57 4.4 Age at First Sexual Intercourse ......................................................................................... 57 4.5 Recent Sexual Activity ...................................................................................................... 58 5 FERTILITY ................................................................................................................................... 69 5.1 Current Fertility ................................................................................................................. 69 5.2 Children Ever Born and Living ......................................................................................... 70 5.3 Birth Intervals .................................................................................................................... 71 5.4 Insusceptibility to Pregnancy ............................................................................................. 71 5.5 Age at First Birth ............................................................................................................... 73 5.6 Teenage Childbearing and Sexual and Reproductive Behaviours before Age 15 ............. 73 5.6.1 Teenage Childbearing .......................................................................................... 73 5.6.2 Sexual and Reproductive Behaviours before Age 15 .......................................... 74 6 FERTILITY PREFERENCES ..................................................................................................... 83 6.1 Desire for Another Child ................................................................................................... 83 6.2 Ideal Family Size ............................................................................................................... 84 6.3 Fertility Planning Status .................................................................................................... 85 6.4 Wanted Fertility Rates ....................................................................................................... 86 7 FAMILY PLANNING .................................................................................................................. 93 7.1 Contraceptive Knowledge and Use ................................................................................... 93 7.2 Source of Modern Contraceptive Methods ........................................................................ 95 7.3 Informed Choice ................................................................................................................ 96 7.4 Discontinuation of Contraceptives .................................................................................... 97 7.4.1 Knowledge of the Fertile Period .......................................................................... 97 7.5 Demand for Family Planning ............................................................................................ 97 7.5.1 Decision-making about Family Planning ............................................................. 99 7.5.2 Future Use of Contraception ................................................................................ 99 7.5.3 Exposure to Family Planning Messages in the Media ......................................... 99 7.6 Contact of Nonusers with Family Planning Providers ....................................................... 99 8 INFANT AND CHILD MORTALITY ...................................................................................... 111 8.1 Infant and Child Mortality ............................................................................................... 112 8.2 Biodemographic Risk Factors ......................................................................................... 113 8.3 Perinatal Mortality ........................................................................................................... 113 9 MATERNAL HEALTH CARE ................................................................................................. 119 9.1 Antenatal Care Coverage and Content ............................................................................ 120 9.1.1 Skilled Providers ................................................................................................ 120 9.1.2 Timing and Number of ANC Visits ................................................................... 120 9.2 Components of ANC Visits ............................................................................................. 121 9.3 Protection against Neonatal Tetanus ............................................................................... 121 9.4 Delivery Services ............................................................................................................. 122 9.4.1 Institutional Deliveries ....................................................................................... 122 9.4.2 Skilled Assistance during Delivery .................................................................... 123 9.4.3 Delivery by Caesarean ....................................................................................... 123 9.5 Postnatal Care .................................................................................................................. 124 9.5.1 Postnatal Health Check for Mothers .................................................................. 124 9.5.2 Postnatal Health Checks for Newborns ............................................................. 125 9.6 Obstetric Fistula ............................................................................................................... 125 9.7 Problems in Accessing Health Care ................................................................................ 126 iv • Contents
10 CHILD HEALTH ........................................................................................................................ 141 10.1 Birth Weight .................................................................................................................... 141 10.2 Vaccination of Children ................................................................................................... 142 10.2.1 Vaccination Coverage ........................................................................................ 142 10.2.2 Uptake of the Newly Introduced Vaccines ........................................................ 143 10.2.3 Vaccination Card Ownership and Availability .................................................. 144 10.3 Symptoms of Acute Respiratory Infection ...................................................................... 144 10.4 Fever ................................................................................................................................ 144 10.5 Diarrhoeal Disease ........................................................................................................... 145 10.5.1 Prevalence of Diarrhoea and Treatment Seeking Behaviour ............................. 145 10.5.2 Feeding Practices during Diarrhoea ................................................................... 145 10.5.3 Oral Rehydration Therapy and other Treatments for Diarrhoea ........................ 146 10.5.4 Knowledge of ORS Packets ............................................................................... 146 10.5.5 Treatment of Childhood Illness .......................................................................... 147 10.6 Disposal of Children’s Stools .......................................................................................... 147 11 NUTRITION OF CHILDREN AND WOMEN ........................................................................ 159 11.1 Nutritional Status of Children .......................................................................................... 159 11.1.1 Measurement of Nutritional Status among Young Children .............................. 159 11.1.2 Data Collection .................................................................................................. 161 11.1.3 Levels of Child Malnutrition ............................................................................. 161 11.2 Infant and Young Child Feeding Practices ...................................................................... 162 11.2.1 Breastfeeding ..................................................................................................... 162 11.2.2 Complementary Feeding .................................................................................... 163 11.2.3 Minimum Acceptable Diet ................................................................................. 164 11.3 Anaemia Prevalence in Children ..................................................................................... 166 11.4 Presence of Iodised Salt in Households ........................................................................... 166 11.5 Micronutrient Intake and Supplementation among Children ........................................... 167 11.6 Women’s Nutritional Status ............................................................................................ 167 11.7 Anaemia Prevalence in Women....................................................................................... 168 11.8 Micronutrient Intake among Mothers .............................................................................. 169 12 MALARIA ................................................................................................................................... 183 12.1 Ownership of Insecticide-Treated Nets ........................................................................... 183 12.2 Indoor Residual Spraying ................................................................................................ 185 12.3 Household Access and Use of ITNs ................................................................................ 186 12.4 Use of ITNs by Children and Pregnant Women .............................................................. 187 12.5 Malaria in Pregnancy ....................................................................................................... 187 12.6 Case Management of Malaria in Children ....................................................................... 188 12.7 Prevalence of Low Haemoglobin in Children ................................................................. 189 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR ....................... 201 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods .................................... 202 13.2 Knowledge about Mother-to-Child Transmission ........................................................... 203 13.3 Attitudes toward People Living with HIV ....................................................................... 204 13.4 Multiple Sexual Partners ................................................................................................. 204 13.5 Paid Sex ........................................................................................................................... 205 13.6 Coverage of HIV Testing Services .................................................................................. 206 13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing ........... 206 13.6.2 HIV Testing of Pregnant Women ...................................................................... 207 13.7 Male Circumcision .......................................................................................................... 207 13.8 Self-reporting of Sexually Transmitted Infections .......................................................... 208 13.9 HIV/AIDS-related Knowledge and Behaviour among Young People ............................ 209 Contents • v
Page 1: Malawi Demographic and Health Surve
Page 4 and 5: The 2015-16 Malawi Demographic and
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 36 and 37: The information collected in the 20
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
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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
Page 107 and 108:
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
Page 178 and 179:
• 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’
Page 194 and 195:
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
Page 204 and 205:
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
Page 239 and 240:
Only 1% of all women reported havin
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Page 243 and 244:
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
Page 265 and 266:
The HIV prevalence among women and
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Table 14.1 Coverage of HIV testing
Page 271 and 272:
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
Page 279 and 280:
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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Page 291 and 292:
5% participate in neither decisions
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from 78% to 74%. The percentage of
Page 295 and 296:
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
Page 342 and 343:
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
Page 412 and 413:
Table A-11.2 Initial breastfeeding:
Page 414 and 415:
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
Page 436 and 437:
Table A-13.7.1 Coverage of prior HI
Page 438 and 439:
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
Page 446 and 447:
CHAPTER 14 HIV PREVALENCE Table A-1
Page 448 and 449:
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
Page 460 and 461:
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
Page 479 and 480:
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
Page 485 and 486:
Table B.8 Coverage of HIV testing b
Page 487:
Table B.10 Coverage of HIV testing
Page 490 and 491:
where h represents the stratum whic
Page 492 and 493:
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
Page 498 and 499:
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
Page 539:
Ireen Yohane Chisomo Mkwapatira Des
Page 543 and 544:
2015-2016 MALAWI DEMOGRAPHIC AND HE
Page 545 and 546:
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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