Malawi Longitudinal Study Of Families And Health Research Articles

Resilience, Accelerated Aging and Persistently Poor Health: Diverse Trajectories of Health in Malawi.

Individuals age at vastly different rates resulting in significant within-population heterogeneity in health and aging outcomes. This diversity in health and aging trajectories has rarely been investigated among low-income aging populations that have experienced substantial hardships throughout their lifecourses. Utilizing 2006-2018 data from the Malawi Longitudinal Study of Families and Health (MLSFH) and estimating group-based trajectory models (GBTM), our analyses identified three distinct lifecourse health trajectories: (1) comparatively good initial mental and physical health that persisted throughout the lifecourse ("resilient aging"); (2) relatively good initial mental and physical health that started to deteriorate during mid-adulthood ("accelerated aging"); and (3) poor initial mental and physical health that further declined over the lifecourse ("aging with persistently poor health"). For both physical and mental health, men were more likely to enjoy resilient aging than women. Predictors other than gender of trajectory membership sometimes confirmed, and sometimes contradicted, hypotheses derived from high-income country studies. Our analyses highlight the long arm of early life conditions and gender in determining aging trajectories and show that a non-trivial sub-population is characterized by aging with persistently poor health. The study uncovers widening gaps in health outcomes between those who age with resilience and those who experience accelerated aging.

A marginal structural model for estimation of the effect of HIV positivity awareness on risky sexual behavior

In this paper, a Marginal Structural Model (MSM) with inverse probability of treatment weights was used to estimate the causal effect of HIV positivity awareness on condom use and multiple sexual partners using data from the Malawi Longitudinal Study of Families and Health (MLSFH). Cumulative awareness of HIV positivity was measured as the number of times an individual was aware of their positive HIV status. Awareness of HIV positivity was associated with increased condom use (OR=2.22, 95%: (1.79, 2.75)). Only among women was it associated with multiple sexual partners (OR=1.76, 95%: (1.36, 2.28)). The use of MSM (over standard regression models for repeated measures) should be encouraged as it is more suited for assessing the cumulative treatment effects while controlling for time-varying confounders in longitudinal studies. There is a need to up-scale interventions that promote HIV testing, awareness of HIV status, and prevention of HIV transmission.

Curtailing Covid-19 on a dollar-a-day in Malawi: Role of community leadership for shaping public health and economic responses to the pandemic.

Utilizing population-based data from the Covid-19 phone survey () of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd–August 17th, 2020, we focus on the crucial role that community leadership and trust in institutions played in shaping behavioral, economic and social responses to Covid-19 in this low-income sub-Saharan African context. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leadership to mobilize communities to adapt and adhere to Covid-19 prevention strategies. Using linear and ordered probit models and controlling for time fixed effects, we show that village heads (VHs) played pivotal role in shaping individuals’ knowledge about the pandemic and the adoption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals’ behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to Covid-19 will remain the primary prevention strategy for a foreseeable future.

A longitudinal multilevel analysis of the evermigrated population subjective HIV infection expectation in Malawi

Objective The primary purpose of this study is to assess the variance in the effects of factors influencing ever migrated Malawian population’s subjective HIV infection expectation. Design Using data from the Malawi Longitudinal Study of Families and Health (MLSFH) survey (1998-2010), 7805 ever migrated Malawian adults were selected for the study. Summary statistics, logistic regression and longitudinal multi-level models were fitted for the study. A binary logistic regression was used to estimate the direction and magnitude of the associations between the variables selected for the study Five multilevel models with random intercepts and coefficients nominal response were fitted. Results The study revealed that sexual behaviours had the most significant effect on ever migrated Malawian’s subjective HIV infection expectation. All metrics showed that the conditional growth model had the most signficant outcome. The addition of time and other variables as predictors had a significant effect on the conditional growth model. Conclusion Interventions designed to decrease the spread of HIV should target sexual behaviours and widespread testing among the ever migrated population to reduce subjective HIV infection thoughts.

The Longitudinal Dynamics of Household Composition and Wealth in Rural Malawi

Household living arrangements play a crucial role in survival efforts throughout sub-Saharan Africa. Household living arrangements foster the development of informal insurance that can mitigate economic or filial shocks, and potentially improve the overall well-being of kin. However, scholarship in sub-Saharan African settings has not been able to, or has not attempted, to track how households have changed and the coinciding changes in livelihood outcomes. We ask whether changes in overall household size and the addition of dependents and working-age individuals are associated with changes in household wealth, a signal of well-being. We use the Malawi Longitudinal Study of Families and Health (MLSFH) to exploit detailed data on changing Malawian household composition via a household roster matching technique and fixed effects regressions. The addition of members to a household and the presence of more boys and working-age men—to a certain point—are associated with having more durable goods and greater chances of acquiring a metal roof—key indicators of wealth in rural Malawi. The addition of girls and women of any age are seemingly not linked to changes in household wealth.

Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population

Cognitive health is an important dimension of well-being in older ages, but few studies have investigated the demography of cognitive health in sub-Saharan Africa's (SSA) growing population of mature adults (= persons age 45+). We use data from the Malawi Longitudinal Study of Families and Health (MLSFH) to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age-pattern of decline in cognitive health is broadly similar to that observed in the U.S. We also find that women have substantially worse cognitive health than men, and experience a steeper age-gradient in cognitive ability. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety, and are associated with worse physical health measured through both self-reports and physical performance. Our findings suggest that cognition plays a key-but understudied-role in shaping late-life well-being in low-income populations.

Why rely on friends instead of family? The role of exchanges and civic engagement in a rural sub-Saharan African context

ABSTRACTSocial science research has shown there is a nearly universal norm of seeking assistance from family members in times of need. However, when do individuals prefer to rely on friends, rather than family members, when they need support? This question has not been carefully addressed. To fill this gap in the literature we examine why rural Malawians – who typically have strong bonds with kin – might prefer to rely on friends instead of family if a crisis were to occur. Using the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health (MLSFH), we consider how financial and non-financial exchanges with kin, and civic engagement, are associated with the composition of individuals’ support networks. We find the decision to request a friend’s help during a crisis is consistently associated with participation in civic-oriented activities, expanding our understanding of the determinants of different risk-pooling strategies.

Acceptance of Intimate Partner Violence in Rural Malawi: An Empirical Analysis on the Impacts of Lineage and AIDS Conversation Networks

Acceptance of intimate partner violence (IPV) is both a barrier to its reduction and a strong predictor of prevalence. This study examines whether lineage and AIDS conversation networks impact acceptance of IPV among men and women in rural Malawi. The sample consists of 4,422 male and female respondents from the 2001, 2004, and 2006 waves of the Malawi Longitudinal Study of Families and Health (MLSFH). The longitudinal nature of the data enables us to use not only random effects models in the empirical analysis, but also fixed effects models, which help alleviate omitted variable bias. Our findings suggest that in the patrilineal Northern Region of Malawi, AIDS conversation networks may be conducive toward reducing acceptance of IPV. However, AIDS conversation networks may reinforce violent norms in the Central Region of Malawi as men with larger AIDS conversation networks are more accepting of IPV. These findings imply there may be an opportunity to incorporate network-based policies to reduce IPV, and lineage may be an important consideration in forming policies to alleviate IPV. In addition, we find a relatively strong age-acceptance gradient, with younger, never-married individuals being less accepting of IPV than older, married individuals. This finding may help inform intervention targeting as older, married women in Malawi may be at a higher risk of IPV.

Living Arrangements and Health at Older Ages in Rural Malawi.

Sub-Saharan Africa's older population is projected to nearly double in size by 2030. At the same time, demographic changes have caused major shifts in the units primarily responsible for the care of older adults: the family and household. The purpose of this paper is to examine the relationship between household composition and health at older ages in rural Malawi. We use data from the Malawi Longitudinal Study of Families and Health (MLSFH), which contains detailed information on household and family structure, along with measures of mental and physical health (from the Short Form-12). We focus on several measures of living arrangements that are expected to be associated with health: overall household size, sex composition, and kin structure (based on co-residence with offspring and grandchildren). Results show that: (1) older women who co-reside with offspring have better mental and physical health compared to those living only with grandchildren; (2) older men who live in larger households or in households with a higher proportion of females have better physical health.

Parental Divorce and Children's Schooling in Rural Malawi.

A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.

Forgotten marriages? Measuring the reliability of marriage histories.

BACKGROUNDMarriage histories are a valuable data source for investigating nuptiality. While researchers typically acknowledge the problems associated with their use, it is unknown to what extent these problems occur and how marriage analyses are affected.OBJECTIVEThis paper seeks to investigate the quality of marriage histories by measuring levels of misreporting, examining the characteristics associated with misreporting, and assessing whether misreporting biases marriage indicators.METHODSUsing data from the Malawi Longitudinal Study of Families and Health (MLSFH), I compare marriage histories reported by the same respondents at two different points in time. I investigate whether respondents consistently report their spouses (by name), status of marriage, and dates of marriage. I use multivariate regression models to investigate the characteristics associated with misreporting. Finally, I examine whether misreporting marriages and marriage dates affects marriage indicators.RESULTSResults indicate that 28.3% of men and 17.9% of women omitted at least one marriage in one of the survey waves. Multivariate regression models show that misreporting is not random: marriage, individual, interviewer, and survey characteristics are associated with marriage omission and marriage date inconsistencies. Misreporting also affects marriage indicators.CONCLUSIONSThis is the first study of its kind to examine the reliability of marriage histories collected in the context of Sub-Saharan Africa. Although marriage histories are frequently used to study marriage dynamics, until now no knowledge has existed on the degree of misreporting. Misreporting in marriage histories is shown to be non-negligent and could potentially affect analyses.

The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, and Condom Use With Spouses.

This article assesses how married individuals' knowledge of HIV status gained through HIV testing and counseling (HTC) affects divorce, the number of sexual partners, and the use of condoms within marriage. This study improves upon previous studies on this topic because the randomized incentives affecting the propensity to be tested for HIV permit control for selective testing. Instrumental variable probit and linear models are estimated, using a randomized experiment administered as part of the Malawi Longitudinal Study of Families and Health (MLSFH). The results indicate that knowledge of HIV status (1) does not affect chances of divorce for either HIV-negative or HIV-positive respondents; (2) reduces the number of reported sexual partners among HIV-positive respondents; and (3) increases reported condom use with spouses for both HIV-negative and HIV-positive respondents. These results imply that individuals actively respond to information about their HIV status that they learn during HTC, invoking protective behavior against future risk of HIV/AIDS for themselves and their actual and potential sexual partners. Some limitations of this study are a small sample size for those who are HIV-positive and dependence on self-reported sexual behaviors.

HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment

Although most countries state that fighting social intolerance against persons with HIV is part of their national HIV strategy, the impact of reducing intolerance on risky sexual behavior is largely unknown. In this paper, we estimate the effect of social intolerance against HIV+ persons on risky sexual behavior in rural Malawi using data from roughly 2000 respondents from the 2004 and 2006 waves of the Malawi Longitudinal Study of Families and Health (MLSFH). The effect of social intolerance on risky behavior is a priori ambiguous. On the one hand, higher social intolerance or stigma can lead people to disassociate from the stigmatized group and hence promote risky behavior. On the other hand, intolerance can be viewed as a social tax on being HIV+ and thus higher intolerance may reduce risky behavior. We find that a decrease in social intolerance is associated with a decrease in risky behavior, including fewer partners and a lower likelihood of having extra-marital relations. This effect is mainly driven by the impact of social intolerance on men. Overall the results suggests that reducing social intolerance might not only benefit the HIV positive but might also forestall the spread of HIV.

Cohort Profile: The Malawi Longitudinal Study of Families and Health (MLSFH).

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-standing, publicly available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries. The MLSFH was initially established in 1998 to study social network influences on fertility behaviours and HIV risk perceptions, and over time the focus of the study expanded to include health, sexual behaviours, intergenerational relations and family/household dynamics. The currently available data include MLSFH rounds collected in 1998, 2001, 2004, 2006, 2008, 2010 and 2012 for up to 4000 individuals, providing information about socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MLSFH public use data can be requested on the project website: http://www.malawi.pop.upenn.edu/.

Association of blood lipids, creatinine, albumin, and CRP with socioeconomic status in Malawi.

BackgroundThe objective of these analyses is to document the relationship between biomarker-based indicators of health and socioeconomic status (SES) in a low-income African population where the cumulative effects of exposure to multiple stressors on physiological functions and health in general are expected to be highly detrimental for the well-being of individuals.MethodsBiomarkers were collected subsequent to the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), a population-based study in rural Malawi, including blood lipids (total cholesterol, LDL, HDL, ratio of total cholesterol to HDL), biomarkers of renal and liver organ function (albumin and creatinine) and wide-range C-reactive protein (CRP) as a non-specific biomarker for inflammation. These biomarkers represent widely used indicators of health that are individually or cumulatively recognized as risk factors for age-related diseases among prime-aged and elderly individuals. Quantile regressions are used to estimate the age-gradient and the within-day variation of each biomarker distribution. Differences in biomarker levels by socioeconomic status are investigated using descriptive and multivariate statistics.ResultsOverall, the number of significant associations between the biomarkers and socioeconomic measures is very modest. None of the biomarkers significantly varies with schooling. Except for CRP where being married is weakly associated with lower risk of having an elevated CRP level, marriage is not associated with the biomarkers measured in the MLSFH. Similarly, being Muslim is associated with a lower risk of having elevated CRP but otherwise religion does not predict being in the high-risk quartiles of any of the MLSFH biomarkers. Wealth does not predict being in the high-risk quartile of any of the MLSFH biomarkers, with the exception of a weak effect on creatinine. Being overweight or obese is associated with increased likelihood of being in the high-risk quartile for cholesterol, Chol/HDL ratio, and LDL.ConclusionsThe results provide only weak evidence for variation of the biomarkers by socioeconomic indicators in a poor Malawian context. Our findings underscore the need for further research to understand the determinants of health outcomes in a poor low-income context such as rural Malawi.

Intergenerational transfers in the era of HIV/AIDS: Evidence from rural Malawi.

Intergenerational transfer patterns in sub-Saharan Africa are poorly understood, despite the alleged importance of support networks to ameliorate the complex implications of the HIV/AIDS epidemic for families. There is a considerable need for research on intergenerational support networks and transfers to better understand the mechanisms through which extended families cope with the HIV/AIDS epidemic and potentially alleviate some of its consequences in sub-Saharan Africa, and to comprehend how transfers respond-or not-to perceptions about own and other family members' health. Using the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), we estimate the age patterns and the multiple directions of financial and non-financial transfer flows in rural Malawi-from prime-aged respondents to their elderly parents and adult children age 15 and up. We also estimate the social, demographic and economic correlates of financial and non-financial transfers of financial intergenerational transfers in this context. Our findings are that: (1) intergenerational financial and non-financial transfers are widespread and a key characteristic of family relationships in rural Malawi; (2) downward and upward transfers are importantly constrained and determined by the availability of transfer partners (parents or adult children); (3) financial net transfers are strongly age-patterned and the middle generations are net-providers of transfers; (4) non-financial transfers are based on mutual assistance rather than reallocation of resources; and (5) intergenerational transfers are generally not related to health status, including HIV positive status.

Negative Economic Shocks and Child Schooling: Evidence from Rural Malawi

This study investigates the impacts of negative economic shocks on child schooling in households of rural Malawi, one of the poorest countries in Sub-Saharan Africa (SSA). Two waves of household panel data for years 2006 and 2008 from the Malawi Longitudinal Study of Families and Health (MLSFH) are used to examine the impact of negative shocks on child schooling. Both individually-reported and community-level shocks are investigated. A priori the impact of negative shocks on schooling may be negative (if income effects dominate) or positive (if price effects dominate). Also the effects may be larger for measures of idiosyncratic shocks (if there is considerable within-community variation in experiencing shocks) or for aggregate shocks (if community support networks buffer better idiosyncratic than aggregate shocks). Finally there may be gender differences in the relevance for child schooling of shocks reported by men versus those reported by women with, for example, the former having larger effects if resource constraints have strong effects on schooling and if because of gender roles men perceive better than women shocks that affect household resources. The study finds that negative economic shocks have significant negative impacts on child school enrollment and grade attainment, with the estimated effects of the community shocks larger and more pervasive than the estimated effects of idiosyncratic shocks and with the estimated effects of shocks reported by men as large or larger than the estimated effects of shocks reported by women.

Evaluating health and disease in Sub-Saharan Africa: minimally invasive collection of plasma in the Malawi Longitudinal Study of Families and Health (MLSFH).

The collection of biomarker-based indicators of adult health is an important addition to socioeconomic surveys since they can provide valuable insights into the biological functions, and the complex causal pathways between socioeconomic environments and health outcomes. We document the collection of blood-plasma based biomarkers as a pilot project within the Malawi Longitudinal Study of Families and Health (MLSFH). Using the LabAnywhere system as a minimally-invasive approach previously not used in less-developed countries, we collected biomarkers of lipids, metabolic processes, organ function, and the immune system. Overall, only small proportions of the collected samples are above the upper limits of the normal clinical ranges as defined by western standards. The correlational patterns between the biomarkers are consistent with observations from developed countries and the comparison with other low-income populations shows remarkably similar age-specific patterns of the biomarkers despite differences in the mode of blood sampling. The present study confirms that the collection of biomarker-based indicators of adult health using the LabAnywhere system is feasible in rural sub-Saharan contexts and this approach provides an attractive alternative to the collection of dried blood spots (DBS) and venous blood samples. Iliana V. KOHLER, Researcher and Associate Director, Population Aging Research Center, and  Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: iliana@pop.upenn.edu . Philip ANGLEWCZ, Assistant Professor, School of Public Health & Tropical Medicine and Department of Global Health System and Development, 1440 Canal St., Suite 2200, New Orleans, LA 70112-2737, USA. E-mail: panglewi@tulane.edu . Hans-Peter KOHLER, Frederick J.\ Warren Professor of Demography and Professor in Sociology, Department of Sociology and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104-6299, USA;. E-mail: hpkohler@pop.upenn.edu . John F. McCABE, Programmer/Data Analyst, Population Aging Research Center (PARC), University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: mccabef@pop.upenn.edu . Ben CHILIMA, Director, Community Health Sciences Unit, Ministry of Health and Population Community Health Sciences Unit, Private Bag 65, Lilonge, Malawi. E-mail: bchilima2@yahoo.com . Beth J. SOLDO, Distinguished Senior Scholar in Sociology, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: bsoldo@pop.upen.edu

Income, health, and well-being in rural Malawi.

This paper attempts to isolate the causal link of income on health status and subjective well-being for the rural population in Malawi using three waves of household panel data spanning the period 2004-2008 from the Malawi Diffusion and Ideational Change Project (MDICP) and the Malawi Longitudinal Study of Families and Health (MLSFH). Malawi is a low-income country with high background morbidity and mortality, as well as an AIDS epidemic, high fertility, and poor reproductive health. Instrumental variables and fixed effects strategies are used to try to address endogeneity of the income to health relationship. The analyses show that a 10% increase in income improves mean general health status of rural Malawians by 1.0% and mean subjective well-being by 1.2%.