Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi.

This study explores sociocultural and other risk factors associated with unplanned teenage pregnancy in Zomba district of Malawi. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews held at five antenatal clinics. The data were analysed using descriptive statistics, frequency tables and chi-square analysis which allowed comparative understanding of the sociocultural risk factors for planned and unplanned teenage pregnancy in Zomba district. The findings revealed that teenage pregnancy is a major health and social problem. Over 76% of the teenage respondents in the study had experienced unplanned pregnancy. Among the prominent factors that stood out in the analysis for this high rate of teenage pregnancy were early sex and marriage, low contraceptive use, low educational levels, low socio-economic status, lack of knowledge of reproductive and sexual health, gender inequity, and physical/sexual violence. The consequences on teenage mothers of unplanned pregnancy have been tragic and have compromised their physical, psychological and socioeconomic wellbeing, not just on them but also their families and society at large. The findings point to the need for a multi-sectoral approach to tackle the problem on teenage pregnancy in this district, and likely throughout Malawi.

Assessing the reduction in infant mortality rates in Malawi over the 1990-2010 decades.

One of the key objectives of the Millennium Development Goals (MDGs) was to improve the lives of infants and children, particularly the reduction of high infant and childhood mortality rates throughout the developing world. This paper examines the experiences of Malawi in tackling the problem of high infant and childhood mortality over recent decades, 1990-2010. We highlight the strategies that were used in Malawi which led to Malawi's stellar performance in achieving the targets set by the MDGs with reference to infant and childhood mortality. The data for the analysis were obtained from Demographic and Health Surveys and from the various censuses the country has conducted. Regression analysis using district as the unit of observation reveals several important factors that have led to the commendable declines in infant mortality. Significant factors included immunisation of infants as well as increasing levels of female education and the availability of skilled birth attendants. What Malawi's case demonstrates is that given a correct mix of strategies, even a poor country such as Malawi can meet some of the lofty targets set by the MDGs.

Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework.

BACKGROUND: Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. METHODS: We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. RESULTS: The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. CONCLUSION: The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.

Analyzing spatial clustering and the spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of Malawi, 1994-2010.

BACKGROUND: Although local spatiotemporal analysis can improve understanding of geographic variation of the HIV epidemic, its drivers, and the search for targeted interventions, it is limited in sub-Saharan Africa. Despite recent declines, Malawi's estimated 10.0% HIV prevalence (2011) remained among the highest globally. Using data on pregnant women in Malawi, this study 1) examines spatiotemporal trends in HIV prevalence 1994-2010, and 2) for 2010, identifies and maps the spatial variation/clustering of factors associated with HIV prevalence at district level. METHODS: Inverse distance weighting was used within ArcGIS Geographic Information Systems (GIS) software to generate continuous surfaces of HIV prevalence from point data (1994, 1996, 1999, 2001, 2003, 2005, 2007, and 2010) obtained from surveillance antenatal clinics. From the surfaces prevalence estimates were extracted at district level and the results mapped nationally. Spatial dependency (autocorrelation) and clustering of HIV prevalence were also analyzed. Correlation and multiple regression analyses were used to identify factors associated with HIV prevalence for 2010 and their spatial variation/clustering mapped and compared to HIV clustering. RESULTS: Analysis revealed wide spatial variation in HIV prevalence at regional, urban/rural, district and sub-district levels. However, prevalence was spatially leveling out within and across 'sub-epidemics' while declining significantly after 1999. Prevalence exhibited statistically significant spatial dependence nationally following initial (1995-1999) localized, patchy low/high patterns as the epidemic spread rapidly. Locally, HIV "hotspots" clustered among eleven southern districts/cities while a "coldspot" captured configurations of six central region districts. Preliminary multiple regression of 2010 HIV prevalence produced a model with four significant explanatory factors (adjusted R2 = 0.688): mean distance to main roads, mean travel time to nearest transport, percentage that had taken an HIV test ever, and percentage attaining a senior primary education. Spatial clustering linked some factors to particular subsets of high HIV-prevalence districts. CONCLUSIONS: Spatial analysis enhanced understanding of local spatiotemporal variation in HIV prevalence, possible underlying factors, and potential for differentiated spatial targeting of interventions. Findings suggest that intervention strategies should also emphasize improved access to health/HIV services, basic education, and syphilis management, particularly in rural hotspot districts, as further research is done on drivers at finer scale.

Vulnerability to HIV/AIDS among women of reproductive age in the slums of Delhi and Hyderabad, India.

This report explores how vulnerability to HIV/AIDS applies to women in the reproductive age range living in the slum areas of Delhi and Hyderabad. The paper is based on a qualitative study of AIDS awareness levels conducted during the summer of 2006. It offers insightful narratives from a sample of 32 women, providing an in depth view of their vulnerability to HIV/AIDS due to their precarious socioeconomic conditions and low AIDS awareness. The women cited lack of education, low empowerment in expressing and accessing information related to sexual matters, and poverty as key factors to vulnerability.

Concern and practice among men about HIV/AIDS in low socioeconomic income areas of Lilongwe, Malawi.

The HIV prevalence rate in Malawi, currently estimated to be 15%, is among the highest in the world. There is a growing realization that in order to understand the underlying causes and devise more effective prevention strategies focus should be placed on economic, political, social, and cultural forces as well as perceptions of individual risk to HIV/AIDS. During 2003 we conducted field work in Lilongwe, the capital city of Malawi, to examine perceptions of individuals as to their risk to HIV infection using the structured interviews and the focus group discussions with men from five areas of Lilongwe. The discussion in this paper focuses on the perception of risk to HIV infection among men in low socioeconomic income areas that we interviewed. Our findings indicate that while knowledge about HIV/AIDS and the best ways in which one can protect oneself from getting HIV is very high, people continue to engage in at-risk behaviors without using the necessary protection. Many of the men in our sample indicated that they were indeed at risk of getting infected with HIV. In spite of this, some of the respondents in both the structured interviews and the focus group discussions pointed out that some people had began taking measures to protect themselves, such as using condoms with nonregular partners, women leaving their husbands where cheating was obvious, and, for men, reducing the number of extra-marital sexual relations.

Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS.

Malawi, a very poor country located in southern Africa, is no exception to the growing trend and severity in HIV prevalence. By the end of 2003 there were 900 000 adults and children in Malawi living with HIV/AIDS. Adult prevalence was estimated to be 15%, which is higher than the 7.1% average rate for sub-Saharan Africa. In order to understand the spread of HIV/AIDS it is imperative to address the economic, social, cultural, and political issues that impact on women's contraction and spread of the virus. We do so in this paper by critically examining the gendered context of HIV/AIDS with reference to Malawi. The theoretical framework for this research focuses on poverty, gender relations, regional migration patterns, and global economic changes which place women in highly vulnerable situations. The study was conducted in a low-income area in Lilongwe, the capital city of Malawi. In 2003 and 2004, 60 randomly selected women who lived in a low socioeconomic residential area completed a structured interview on issues concerning individual economic situations, marriage history, fertility, family planning and social networks, gender, sexual partnerships, and HIV/AIDS. Focus group interviews were also conducted with an additional 20 women. The results of our study indicate that the rising epidemic among women in Malawi is firstly driven by poverty which limits their options. Secondly, gender inequality and asymmetrical sexual relations are basic to spreading HIV/AIDS among women. Thirdly, in spite of their awareness through media and health care professionals, women are unable to protect themselves, which further increases their vulnerability.