Youth In Malawi Research Articles

Young people’s lived sexual and reproductive health citizenship: participation and power of youth in Malawi

ABSTRACT This qualitative, focused critical ethnographic study explores how young people’s ‘lived SRH citizenship’ and their active roles realising their sexual and reproductive health (SRH) and rights, shape their agency and participation in decision-making in Malawi. Informed by postcolonial feminist and difference-centred citizenship theories, our findings reveal that age-based power differentials, systems of gerontocracy and a culture of adultism impede bona fide youth involvement in SRH policymaking, making young citizens’ participation more of an illusion than reality. Although democratisation and decentralisation aim to promote youth engagement, SRH policy spaces/processes lack institutionalised processes for integrating youth and remain dominated by donors and government. Collective efforts to build young citizens’ capacity and to support their engagement are essential for realising their active and meaningful participation in SRH decision-making. Recognising youth as equal members of society is vital to expose systemic gerontocracy/adultism, and democratise power to youth in Malawi, and beyond.

Prevalence and determinants of condom use among the youth in Malawi: evidence from the 2015/16 Malawi Demographic and Health Survey

BackgroundUnprotected sexual intercourse among the youth is common in Malawi. This has led to high rates of sexually transmitted infections (STIs), Human Immunodeficiency Virus (HIV), and unplanned pregnancies. The study investigated the prevalence and the determinants of male and female condom use for the prevention of sexually transmitted infections and unplanned pregnancies among the youth in Malawi.MethodsThe 2015/2016 Malawi Demographic and Health Survey (MDHS) data were used among 15 to 24-year-old male and female who had sexual intercourse four months preceding the survey. A total of 1543 male and 5143 female were selected from 3226 male and 10,367 female respectively and analyzed with SPSS version 20 using.descriptive, bivariate, and logistic regression.ResultsThe study found a low prevalence (27.1%) of condom use among the youth in the last sexual intercourse within four months before the survey. More male (55.8%) used condoms than female (18.5%). The significant predictors of condom use among the male and female youth were: being sexually active (OR 0.39 CI 0.33–0.47), aged 20–24 (OR 0.80 CI 0.68–0.95), ever married (OR 0.07 CI 0.06–0.08), coming from central region (OR 0.56 CI 0.40–0.77), and southern region (OR 0.59 CI 0.42–0.83), residing in the rural area (OR 0.74 CI 0.61–0.90) and ever tested of HIV (OR 1.29 CI 1.03–1.55).ConclusionHaving established low prevalence of condom use among the youth in Malawi, there is a need to scale up programs and policies that target the youth to practice safe sex, which will assist in addressing the challenges of STIs, including HIV, and preventing unplanned pregnancies in Malawi.

Voice of incarcerated male youths in Malawi’s semi-urban prisons: a qualitative study

ObjectiveIncarcerated male youths in Malawi’s detention facilities face multiple threats to their health and well-being. The most common challenges are overcrowding, poor sanitation and a lack of access to basic...

Facility-based HIV self-testing strategies may substantially and cost-effectively increase the number of men and youth tested for HIV in Malawi: results from an individual-based mathematical model.

IntroductionMalawi is rapidly closing the gap in achieving the UNAIDS 95‐95‐95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low‐cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility‐based HIV testing modalities and determine the most cost‐effective strategy to increase the proportion of men and youth testing for HIV.MethodsA data‐driven individual‐based model was parameterized with data from a community‐representative survey (socio‐demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self‐testing (HIVST) and provider‐initiated‐testing‐and‐counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12‐month period, cost‐effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios.ResultsFacility‐based HIVST offered year‐round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%–83%), was considered cost‐saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year‐round HIVST in the OPD remained on the cost‐effectiveness frontier.ConclusionsFacility‐based HIVST is a cost‐effective strategy to increase the proportion of men/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD—providing additional healthcare worker time for other priority healthcare activities.

Syndemic sex education

ABSTRACT In this article, we consider what would happen if the resources and energy devoted to formal, school-based sex education were redirected into a syndemic sex education approach that centres the individual, social, and structural conditions that shape adolescents’ sexual and reproductive health (SRH). Drawing on a case study of youth in Malawi, we argue that sex education in its current form fails to broadly prevent negative SRH outcomes and meaningfully improve wellbeing. Yet it, and the (female) sexuality it seeks to prevent, remain the subjects of considerable attention and moral anxiety. We call to move beyond sex as a focus for institutionalised teaching and learning, replacing it with holistic efforts to support the wellbeing of young people living in syndemic conditions.

'We do not talk about it': Engaging youth in Malawi to inform adaptation of a mental health literacy intervention.

There is limited knowledge on how to tackle mental health problems among youth in Africa. Literature describing community engagement (CE) approaches in low/middle-income countries (LMICs) health research is sparse. CE with youth from LMICS can help steer and shape culturally relevant interventions for stigmatised topics like mental health, resulting in better healthcare experiences. We share our experience of engaging youth in Malawi through advocacy organisations to inform cultural adaptation of a mental health literacy intervention. Young people were recruited using social media from universities and community youth organisations in Malawi to participate in focus group discussions to help culturally adapt content of an existing mental health literacy intervention. Nine online focus groups with 44 individuals were conducted. Discussions involved views and experiences of mental health, including impact of the coronavirus pandemic. Discussions were recorded, transcribed verbatim and analysed using content analysis. Transcript analyses revealed a vicious cycle of poverty and mental health problems for youth in Malawi. Four key themes were identified, 1) poverty-related socioeconomic and health challenges, 2) no one talks about mental health, 3) lacking mental health support and 4) relationship issues. These themes fed into one another within this vicious cycle which perpetually and negatively impacted their lives. The coronavirus pandemic worsened socioeconomic issues, health challenges, mental health and substance use issues, and burden on Malawi's already weak mental health system. Findings suggest increasing untreated mental health burden among Malawi's youth. It highlights great need to address mental health literacy using existing community structures like educational settings to minimise burden on a weak health system. Online focus groups are an effective way of acquiring views from various young people in Malawi on mental health. This CE approach has grown our stakeholder network, strengthening potential for future CE activities and broader research dissemination.

From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia

Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13–24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50–2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.

The impact of skill acquistion on choice of occupation and destination for migrant youths in Malawi

ABSTRACT The study examines the impact of skill acquisition on choice of destination and occupation for migrant youth in Malawi. This study uses primary data collected under the Youth, Employment and Migration for East and Southern Africa (YEMESA) project. Drawing from multinomial logit and Probit models, the study finds that having technical skills before migrating has a statistical significant effect on migrating to long-established administrative cities with stable markets compared to new and expanding commercial cities. Further, technical skills do not have a statistically significant effect on being an entrepreneur but they increase the conditional probability of being employed for wage. Therefore, evidence from this study does not support the premise that in a rural developing economy like Malawi, technical ability can propel migration decision to a more pro-entrepreneurship destination due to convex returns to skills. Rather, lack of start-up capital remain key and prohibitive in entrepreneurship. The study also shows that women are more likely to be in wage employment than in entrepreneurship indicating that entrepreneurship bottlenecks are more severe among women and thus suggesting a need of women’s financial inclusion. Finally, the study also ascertains the role of information and expectations in the decision to migrate.

Gender earnings gap among the youth in Malawi

AbstractWhile young women's engagement in economic activities is an essential component of development, gender gaps are still commonly observed worldwide and especially in developing countries like Malawi. This study introduces recent data to provide new evidence for a sub‐Saharan country that has yet been closely examined. Using the International Labour Organization's School‐to‐Work Transition Survey (ILO SWTS) individual‐level data, I examine the gender earnings gap among the youth in Malawi by conducting Mincer earnings regressions with Heckman selection correction and applying Blinder–Oaxaca decomposition methods. I find that young women in Malawi earn significantly less than young men and that women are significantly less likely to engage in income‐generating work activities. Also, substantial unadjusted gender earnings difference in Malawi is overwhelmingly due to differences in returns. Moreover, detailed decomposition results show that gender differences in work‐related individual characteristics and firm characteristics also contribute to the gender earnings gap. The results suggest that any effort to reduce the gender earnings gap should involve improved access to education as well as better workplaces for women.

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania.

Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called “An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania” (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a “hub and spoke” model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

Determinants of Risky Sexual Behaviour among the Youths in Malawi

Determinants of Risky Sexual Behaviour among the Youths in Malawi

Youth accessing reproductive health services in Malawi: drivers, barriers, and suggestions from the perspectives of youth and parents

BackgroundMalawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate. However, youth, 15–24 years, have not had the same successes. Teenage pregnancies are on the rise and little progress has been made in reducing unmet need for family planning among youth. With two-thirds of the population under the age of 25 and with Malawi’s rapid population growth, reducing unmet need for family planning among youth remains a priority for the government’s reproductive health agenda. To further explore this situation, we conducted a qualitative study to explore the perspectives of youth and adults about the drivers and barriers to youth accessing family planning in Malawi and their ideas to improve services.MethodsWe conducted 34 focus group discussions with youth aged 15–24 and parents or legal guardians of female youth in 3 districts in Malawi. Focus groups were translated and transcribed. Data was input into Dedoose and analyzed using a thematic framework to identify broader patterns and themes.ResultsYouth participants felt motivated to use family planning to protect themselves from sexually transmitted diseases and to prevent unwanted pregnancies. Females focused on the consequences of unplanned pregnancies and believed family planning services were targeted primarily at them, while males thought family planning services targeted males and females equally. Barriers to youth accessing family planning included contraception misconceptions, the costs of family planning services, and negative attitudes. Parents had mixed views on family planning. While many parents acknowledged they could play a role in supporting youth, most said they are reluctant to support youth using family planning. Participants said improving counseling services, integrating family planning services and education within school curricula, and utilizing youth clubs could improve family planning services for youth.ConclusionsPolicy makers and program implementers should consider the diverse preferences among youth and parents and continue seeking their input when designing policies and programs. Youth clubs and school-based services were among the most common suggestions. However, the effectiveness of youth clubs and school-based initiatives to increase contraceptive use among youth in Malawi is not clear.

Agricultural Policy, Employment Opportunities and Social Mobility in Rural Malawi

Despite the youth accounting for more than half of the population of Malawi, they have been marginalized and pushed to the periphery of several development policy interventions. This article interrogates the question of how the youth and policy-makers view agricultural development as a means of social mobility for youth in Malawi. The paper argues that even though agricultural production is the main occupation in Malawi, young people do not value agriculture as a means of upward social mobility. Furthermore, youth and agriculture policy frameworks provide little support to youth in terms of access to affordable farm inputs, land, extension services, value addition initiatives, and markets. It is argued that Malawi is missing the strategic policy direction by not implementing non-traditional agriculture interventions that would engage the youth in a bid to reduce massive youth unemployment.

Social networks, social participation, and health among youth living in extreme poverty in rural Malawi

AbstractExtensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth's social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence.

Sexual Activity of the Youth Population in Malawi: The Emerging Health Care Scenario

The sexual behaviour of youths in Malawi is believed to play an important role in the spread of sexually transmitted infections (STIs). Relevant data from the Malawi Demographic and Health Survey 2010 and a sample of 16,217 youths aged 15–24 have been studied and subjected to bivariate and logistic regression analysis. The results show that married youths were not interested in using condoms (94.2%, p < 0.05) and that those who were living together were 69 times (OR = 1.69, 95% CI, 1.26–2.26) more likely to be involved in early sexual activity than those who were not living together. It is argued that the results should help other researchers, policy makers and planners to create strategies to encourage these youths make use of contraception.

Correlates of Early Sexual Debut and Its Associated STI/HIV Risk Factors among Sexually Active Youths in Malawi

This study explores the correlates of early sexual debut and risk factors of sexually transmitted infections (STIs) among the youth in Malawi. Data was obtained from the Malawi Demographic Health Survey 2010. Out of a sample of 2987 males and 9559 females aged 15–24 years, 1405 males and 5217 females were considered. Chi-square and multivariate analysis was performed and findings presented by gender. The results indicate that females aged 15–19 years (OR=4.18), who were Muslims (OR=1.42), with no education (OR=3.99), were significantly more likely to initiate sexual debut early. Meanwhile, males aged 15–19 years (OR=3.50), from the northern region (OR=2.35) and of the Chewa ethnic group (OR=1.45) were significantly more likely to initiate sexual debut early. Muslims males (OR=0.57), from the poorest (OR=0.69) households were significantly less likely to initiate sexual debut early. Females who initiate sex earlier form a distinct risk group in this study. Specific intervention is therefore needed for young females in their early teen years before they initiate sexual debut.

Associated Risk Factors of STIs and Multiple Sexual Relationships among Youths in Malawi.

BackgroundHaving unprotected sex with multiple sexual partners (MSP) is the greatest risk factor for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among youths. Young people with MSPs are less likely to use a condom and the greater the risk for STIs. This study examines the associated risk factors of STIs and multiple sexual partnerships among youths aged 15–24 years.Data and MethodsThe Malawi Demographic Health Survey 2010 data was used. Out of a sample of 2,987 males and 9,559 females aged 15–24 years, 2,026 males and 6,470 females were considered in the study. Chi square test and logistic regression techniques were performed. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.FindingsThe results indicate that 1,399 (69.0%) males and 2,290 (35.4%) females reported multiple sexual partnerships (MSP). Within the rural area, females (n = 1779) were more likely to report MSP than males (n = 1082) and within the urban areas, a higher proportion of females (n = 511) still reported MSP, with males (n = 316). About 78% rural females aged 20–24 years, and about 79% rural males aged 15–19 years reported MSP. The likelihood of MSP was higher among females in the poorest households (OR = 1.31), being married (OR = 5.71) and Catholic males (OR = 1.63), who were married (OR = 1.59). Catholic males (OR = 1.82) in the rural areas, who were married (OR = 1.80) and rural females in the northern region (OR = 1.26) were more likely to have MSP. The odds ratios were higher among urban females in the poorest (OR = 3.45) households who were married (OR = 4.22).ConclusionsHaving more than one sexual partner increases the risk of STIs and sexuality education programs should be introduced that emphasize the danger that surrounds MSP.

Agricultural Policy Processes and the Youth in Malawi

Evidence exists which shows growing disillusionment with and disinterest in agricultural-based livelihoods among the youth in Africa south of the Sahara. This disillusionment raises concerns for the future of agriculture for the developing world as it can lead to higher rural urban migration, unemployment and lowered agricultural productivity. The engagement of youth in agricultural policy formulation processes is seen as one avenue for motivating youth engagement in agriculture. This research seeks to develop a contextual understanding of the level of engagement of youth in agriculture thus providing evidence which can be used to stimulate youth involvement in the sector. Using a mixed-methods approach, this study analyzes the determinants of the engagement by southern African youth in agricultural policy processes using Malawi as a case study. Factor analytic results show that four interlinked latent factors determine youth engagement in agricultural policy processes: political patronage, availability of social amenities, access to information and educational services, and physical accessibility of the community. Results of a social network analysis demonstrate that government departments at the local level that are mandated to work on youth issues are the main hubs of information for youth in agriculture, with the Ministry of Agriculture playing a secondary role. Furthermore, the results show that youth in agriculture have little or no direct interactions with each other; and where interactions do exist, they are weak. Therefore, youth remain on the periphery of agricultural policymaking networks, and their role in shaping agricultural policy dialogues is negligible. This is attributable not only to lack of a deliberate government policy to include the youth but also lack of a unified youth platform. Conclusions are that in southern Africa the onus is on the youth to ensure that they are effectively engaged in agricultural policy dialogue. The creation of unified youth platforms for engaging with agricultural policymakers is essential for improving youth engagement in the policy process. Without such platforms, the voice of the youth on agricultural policy issues will remain barely audible among the cacophony of voices of other agricultural stakeholders.

Disconnect between discourse and behavior regarding concurrent sexual partnerships and condom use: findings from a qualitative study among youth in Malawi

The practice of concurrent sexual partnerships (CP) is posited to be a contributor to the elevated risk of HIV transmission among youth in Malawi. The lens through which Malawian youth conceptualize the practices of CP and condom use has yet to be fully explored. The current study--a secondary data analysis of semi-structured in-depth interviews (n = 19) with Malawian youth aged 18 to 22 years--addresses this gap. Participants were interviewed about their sexual relationships and behavior, as well as their perceptions and knowledge regarding condom use and CP. In order to ensure that youth engaged in CP were oversampled, the recruitment process asked potential respondents to self-identify whether they currently participated in CP. Of the total sample (n = 19), 13 self-identified as currently engaging in CP. Data were analyzed using a grounded theory approach. This qualitative study highlights a disconnect between the high level of knowledge youth exhibit about HIV prevention methods and their actual reported condom use and CP behaviors. While some youth claimed to use condoms, their discourse demonstrated fluidity in that use changed over time, or interest in changing behavior was expressed, or was inconsistent between partnerships. The disconnect between knowledge of the consequences of risky sexual behavior and actual behavior was most evident among inconsistent condom users engaged in CP. This finding indicates knowledge alone has a limited role in the adoption of lower risk behaviors such as condom use and reduction of CP among youth. Moreover, findings from this study can inform HIV prevention programs operating in Malawi and the sub-Saharan Africa region by enabling them to provide tailored, more persuasive health promotion and prevention messaging.

Orphan Status and Time to First Sex Among Adolescents in Northern Malawi

This study examines the effects of orphanhood status on the timing of first sexual intercourse among youth in Malawi. Log-normal models were applied to survey data collected between May and August 2009 from 1,214 adolescents aged 12-18 in Mzuzu, Northern Malawi. Results of this study show that orphanhood is a significant predictor of age at first sex. Male double orphans experienced first sexual intercourse earlier than their male non-orphan peers. Similarly, female maternal and paternal orphans had their sexual debut faster than their non-orphan counterparts. The introduction of social support variables accounted for the orphanhood disadvantage. These findings suggest that in order to delay sexual initiation and reduce HIV risk among orphans in Malawi, policy efforts should focus on enhancing factual knowledge about HIV/AIDS, household food security, social support, and other measures that will strengthen existing social support networks and connectedness of surviving family members.