Condom Knowledge, Attitude and Use Assessment among Males aged 18-49 and Females aged 15-44 years in selected Rural and Urban Areas of Malawi.

• The main objective of this KAP survey was to determine the prevalence and identify barriers towards condom, use among the sexually active males and females in representative rural and urban areas in the three regions of Malawi in order to facilitate appropriate strategies for enhancing condom use promotion for STD/HIV prevention. The study was carried out over a target sample of 900 males aged 18-49 years and 900 female aged 15-44 years from selected rural and urban areas. The findings of the survey indicate that AIDS is generally regarded as the most dangerous STD (93%). The main reasons given were: it has no cure (47%) and causes death (23%). AIDS knowledge remains almost universal (98%), the least knowledgeable category being those with low primary education (93%). The radio (51%) was given as the most important source of AIDS knowledge, followed by health talks (28%). Friends accounted for less than 10% of the responses as source of information regarding HIV/AIDS. More males and urban residents cited the radio as the first source. Health talks and friends were more important for females and rural respondents. Ninety-six per cent (96%) said they know HIV is transmitted through sexual intercourse, 64% stated sharing of razor blades and 28% through sharing toothbrushes or using unsterilized needles. This knowledge is high in the urban areas than in the rural. Ninety-three percent (93%) of the respondents had heard of a condom. Eighty-two percent (82%) were able to correctly identify it. However, only 30% of those who ever used a condom correctly demonstrated all the stages of condom use. The younger, male and urban respondents were more aware. About 55% of females would accept condom use if their partner suggested.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Behavioural Component of the Preparatory AIDS Vaccine Evaluation (PAVE) Studies.

• The main objective of the study was to investigate HIV/AIDS preventive measures of a behavioural nature which can be used together with other biological measures, and later on a vaccine, in the prevention and control of HIV/AIDS transmission. Specifically, the objectives were:- to document the local beliefs regarding etiology, progression, treatment and prevention of HIV/AIDS; to assess the potential rule of the behaviour of husbands and/or wives in the initial HIV infection; to elicit information pertaining to the available contraception methods and their acceptability; and to assess the willingness of men and women to use virucides/ microbicides along sides other methods of contraception and HIV/AIDS prevention. The study was conducted in two sites: QECH and SUCOMA estate at Nchalo in Chikwawa. The sample comprised 32 women at QECH and 55 estate workers at NCHALO estate. In this exercise, focus group interviews were employed to elicit qualitative information. A total of 32 women already enrolled in the PAVE studies at QECH participated in four focus group discussions and interviews. A minimum of 6 and a maximum of 10 women were allowed to participate in each focus group discussion. In Nchalo, 55 estate workers participated in five focus group discussions/ interviews. A focus group discussion guide was used in the interviews. Each focus group interview was of at least 45 minutes duration. However, interviews in Nchalo could sometimes last for more than an hour. In all the FGDs conducted in Blantyre and Nchalo, both men and women were consistent in mentioning AIDS, syphilis, gonorrhoea, chancroid, as some of the STDs. All the groups mentioned that AIDS was the most serious STD because it has no cure and is uniformally fatal. The most common mode of HIV transmission was cited as having unprotected sex with multiple partners. Women suggested that the most effective way of HIV/AIDS prevention is to avoid sex with multiple partners. Most participants had changed their behaviour in the advent of an HIV epidemic. The respondents said that there are some cultural and traditional practices which can actually favour the spread of HIV/AIDS.

Location: CSR,SPU, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Stragey Planning Unit, P.O. BOX 30622, Lilongwe 3, Tel: 265-726 540/724 073

Acceptability of the Female Condom (FEMIDOM) within population of Commercial Sex Workers and Couples in Salima and Nkhotakota, Malawi.

• Examines the acceptability of the Femidom female condom among married or cohabiting couples and CSWs. 111 Couples from Salima Agricultural Development Division (SLADD) and 46 Commercial Sex workers (CSWs) in Salima and Nkhotakota District. CSWs were recruited at STD clinics in Salima and Nkhotakota districts, they were to be not less than 18 years of age and using oral contraceptives or IUCD or female sterilization, and not pregnant or breast feeding at the time of the study. Couples were presented the female condom not just for STD control, but also for child spacing. The study was done in two phases. In phase I respondents were presented the female condoms. In phase II those who do not used the female condom were subjected to a semi-structured questionnaire. 66% of participants like the female condoms very much and further 31% like them fairly well. The female condom was accepted for both contraception and STDs and HIV/AIDS control. The latter is a major women's issue in Malawi. Although the majority of both men and women who participated in this study found female condoms acceptable, there were few who were not willing to use it in the future. Most people in Malawi are aware of the terrible tragedy that surrounds them as AIDS takes its toll. There exists a perceived need for barrier methods, not just to avoid pregnancy, but also for safe sex.

Improving antenatal care for pregnant adolescents in Southern Malawi.

• The objective of this study was to collect descriptive data on the characteristics of 615 adolescents (aged 10-19 years) who attended for a first antenatal care visit at 2 rural hospitals in Southern Malawi were collected. For the 41.5% who came for a supervised delivery, details of their pregnancy care and delivery outcome were obtained. The Chi-square test was used for determining significant differences between age and parity groups and logistic regression for an analysis of low birthweight. Fifty-two percent of girls were nulliparous, 24.5% were less than or equal to 16 years and 73.3% were illiterate. Prevalence of anaemia, malaria and HIV infection was high. Girls who were nulliparous, illiterate, made early antenatal care visits or gave a history of stillbirth or abortion were less likely to attend for delivery. Few primiparae required an assisted vaginal delivery or caesarean section but primiparae had more adverse birth outcomes. Forty percent of primiparae (17 years) gave birth to low birthweight babies as did 28.3% of multiparae. In a logistic regression (all adolescents) low birthweight was correlated with literacy (P=0.03) and number of antenatal care visits (P=0.01). Pregnancy morbidity and adverse birth outcomes were common in spite of antenatal care attendance. This partly reflects poor management of malaria during pregnancy. In areas like Malawi, where childbearing starts early, girls in their first pregnancy need good quality care and careful monitoring if problems are not to be perpetuated to a second pregnancy. Many girls start pregnancy with HIV and schistosoma infections which indicates the need for programmes before girls become pregnant.

Evaluation of the Impact of the Protector Condom Campaign in Malawi.

• Presents the results of the research whose objectives were to build general awareness of condoms and the protection or brand in particular; improve attitudes about condoms, assess brand awareness; image and use among the target audience; to measure changes in condom awareness, attitudes and usage among the target audience (men 18-44 in mid to low income groups) over the past two years since the baseline study was done. The results of the study show that, among urban men in Malawi, attitudes about condoms have improved over the last two years.

Location: CSR Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Early Suckling and Postpartum Haemorrhage; Controlled Trial in Deliveries by Traditional Birth Attendants.

• Determine whether suckling immediately after birth reduces the frequency of postpartum haemorrhage, the mean blood loss, and the frequency of retained placenta. The study was carried out in the Central Region of Malawi, where about half of all deliveries occur outside hospital. The research was carried out only with trained TBAs in Lilongwe district and contiguous traditional authority areas of Kasungu and Mchinji Districts. Randomisation into early suckling and control groups was by TBA rather than by patient. Randomisation of TBAs to treatment or control groups was carried out within districts and after stratification for the number of deliveries attended (More or less than 30 per month), and for distance from a telephone or health centre. Sixty-eight TBAs attended the refresher course before the trial, 33 in the suckling group and 35 in the control group. Blood loss measurements were missing for 114 (59 control group, 55 suckling group) of the 4385 deliveries. The main analysis was carried out on 4229 deliveries of singleton live born babies from mothers whose blood loss was measured (control 2123, suckling 2104). In the suckling group, suckling took place before placental delivery in 889 cases, both before and after in 575, only after placental recorded in 507, and not at all in 32. The information was not recorded in 101 cases. The frequency of PPH did not differ significantly between the groups (suckling 167 [7.9%] vs control 178 [8.4%]; p>0.6 by chi-square test; 95% confidence intervals suckling minus control = -2.1% to + 1.2%). Analysis by the likelihood ratio test showed no evidence of any difference between suckling and control groups in the rate of PHH by individual TBA (p>0.9). Three patients in the suckling group and one in the control group were transferred to hospital with PPH not associated with retained placenta.

Location: COM, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel: 265-677 245/291, Fax:674 700-33, com@malawi.net

An Investigation into Knowledge and Practice of Breast Self-Examination Among Women who Attend Family Planning Clinic.

• A non-experimental, descriptive research design was used in this study. The researcher investigated and described the women's knowledge and practice of breast self examination. The target population was women who attended family planning clinic at KCH, old wing . A systematic random sample was used in this study. Every second women was included in the sample. Forty women were recruited for this study. The idea was to determine breast self-examination practices among women who have attended family planning clinic. An interview schedule was used to collect data from the women. After seeking her consent, the woman was asked questions from the interview schedule. This was conducted in vernacular language. The interviews lasted about 20-25 minutes. A sample size of 40 was obtained from women attending family planning clinic at KCH, old wing. Age distribution was as follows:- 7.5%, (n=3) were in the age bracket 18-21 years; 21.5% (n=11) were in the 22-25 age group; 20% (n=8) in the 26-29 age bracket and 45% (n=18) were aged 30 years and above. On parity of the subjects, 25% (n=10), had between one and two deliveries, 37.5% (n=15) had three to five deliveries. Twelve point five percent had six or more living children, 45% (n=18) had three to five, and 42.5% (n=17) had one to two living children. The majority, 90% (n=36) were married, 7.5% (n=3) were single and 2.5% (n=1) divorced. The findings have also shown that 50% (n=20) of the subjects were Protestants, 37.5% (n=15) were Roman Catholics and 12.5% (n=5) comprised of other denominations.

Location: KCN, Kamuzu College of Nursing (LL), Private Bag 1, Lilongwe, Tel: 265-751 622, Fax: 751 622/752 327-33, Kcnll@sdnp.org.mw

A Descriptive Study of Maternal Deaths in Thyolo District

• The objective of this study was to give the results of a retrospective study regarding the extent of maternal deaths in Thyolo district of Southern Malawi. A sample of over 4,000 respondents was selected from each of the eleven TAs in the district. A maximum of 160 people were chosen for interview from any one of the 32 EAs which were distributed proportionally throughout the 11 TAs and were randomly selected. The whole of the survey area had a matrilineal system of marriage. Two major data collection methods were used to gather data for this study, namely the Sisterhood method. Questionnaire and the in-depth questionnaire. The sisterhood method of collecting data on maternal deaths is an indirect technique for deriving population based estimates of maternal mortality. The in-depth questionnaire was administered to individuals who had a maternal death of a sister. The study results show that most of the deaths (23%) occurred in women of age group 15-19 and 20-24 with a mean age at death of 19.2 years. About 14% of deaths occurring in the age group 30-34 and only 4% of the women dying in the 40+ age group. Twenty-five percent of the deaths occurred during pregnancy, 20% in child birth, and 54% in the postnatal period. Eighteen out of sixty-four deaths (28%) occurred in women who had their first pregnancies and were in the age group 15-19, with 25% of them with 3 pregnancies, in the age group 20-24 and 7% of the dead women had more than 4 pregnancies. 42.5% of the women had delivered 1-3 children at the time of their deaths, and 16.6% had 4-11 children.

Location: KCN, Kamuzu College of Nursing (LL), Private Bag 1, Lilongwe, Tel: 265-751 622, Fax: 751 622/752 327-33, Kcnll@sdnp.org.mw

Safe-Motherhood: Constraints to women's Utilization of Maternal Services in Zomba and Nsanje Districts.

The aim of this study was to determine on the basis of the available information, the factors that act as obstacles to individual women of child-bearing age, in utilizing existing maternal health care services. The target population consisted of currently childbearing women, practicing trained and untrained TBAs and nursing staff involved in maternal health. The study was done in Zomba and Nsanje districts. The main source of data for this dissertation were official documents on maternal services, interview schedules and focus group discussions. Key informants in the areas were also consulted for information pertaining to the general socio-economic status of the areas. The results of the study suggest that the socio-economic and cultural framework in which women operate and make decisions, influences their failure to utilize the maternal services. Service-related problems also play a role in making women fail to go for antenatal clinics, let alone to give birth in a hospital setting. The findings also suggest that removing the indirect socio-economic and cultural factors that constrain women's utilization of maternal services, may help to influence more women to use hospital-based maternal services. Programmes for maternal services should also take into consideration the views of the women for whom they are designed.

Location: CCL-MC,Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

Maternal Mortality in the Thyolo District of Southern Malawi

• Reports the results of a community survey conducted in September, 1989 in Thyolo District, utilizing the Sisterhood Method for estimating the LTR of maternal deaths and then calculating the MMR. It was reporting the results of coupling an in-depth questionnaire with the Sisterhood Method in order to determine the causes of the maternal deaths and use this as a basis for implementing local intervention strategies designed to lower maternal mortality.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Bar Girls Study in Mangochi District.

• The main objective of the study was to find out whether ladies become bar girls by choice or by certain factors. Secondly, to find out what can be done to reduce high risk behaviour and reduce the fast spread of HIV that causes AIDS. The sample comprised of Bargirls working in Mangochi District. Data were collected through a questionnaire and focus group interviews were conducted. The study looked at marriage patterns, district of origin, wages, reason for becoming a bar girl, condom use, business, number of partners and children or dependents. The findings of the study show that girls start high risk behaviour at a young age. It was also revealed that because of early marriages, divorce occurs frequently and that culture has also contributed to this high risk behaviour.

Location: CSR, MOGYCS, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Ministry of Gender, Youth and Community Services, Private bag 330, Lilongwe 3, Tel:770 411, Fax: 770 826-33

Acceptance of Surgery for Trichiasis Among Rural Malawian Women.

• The study was conducted in order to determine the proportion of women with Trichiasis who subsequently accepted surgery and evaluate factors related to acceptance. Women with Trichiasis (recorded as five or more lashes touching the globe) were registered. Age, residence, the number of lashes touching the globe, the presence of a corneal opacity, and best-corrected vision were recorded for all patients. US Peace Corps Volunteers, trained in primary eye care, examined all women attending under five clinics in project villages. These patients were traced to their villages by a trained Malawian interviewer who determined if the patient had undergone surgery and conducted a short close-ended interview to elicit some of the reasons for acceptance or non-acceptance of Trichiasis surgery. Thirty-one women were recognised with Trichiasis, at follow-up, two women had moved and could not be located. Only 11 of the 29 women interviewed (38%), 95% CI: 20.3% - 55.5% received surgical correction of their Trichiasis. Characteristics that described women who accepted surgery were widowhood, low socio-economic status, a start distance to the main road, knowing another women who had surgery for Trichiasis and the presence of Trichiasis in both eyes.

Location: COM, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

High Socio-economic Status (HSES) is a Risk Factor for HIV-1 Infection But not for Sexually Transmitted Diseases (STDs) in Malawian Women.

Examines the relationship between STD and HIV-1 infection in urban pregnant women in Malawi.A to of 5376 women pregnant women presenting prenatal care at Queen Elizabeth Central Hospital were recruited in this study. 5376 pregnant women presenting for prenatal care at Queen Elizabeth Central hospital were interviewed about demographics, medical and sexual history, after that they had a physical/pelvic examination and were tested for syphilis and HIV-1 antibodies. 1220 (22.7%) women were HIV-1 seropositive. Multiple sexual partners and husbands reported partners were positively associated with both HIV-1 infection and current STD. The strongest predictors of HIV-1 infection were HSES (husband's education >8 years) and any current STD. 56% of HIV-1 positive and 33% of HIV-1 negative women were of high HSES, and 64% of HIV-1 positive and 38% of HIV-1 negative women had a current STD. Logistic regression analyses of risk factors for HIV-1 infection and current STD indicated that HSES was a strong risk factor for HIV-1 infection (P<001) but a weak protective factor for STD (P<0.5). The relationships between HSES and HIV-1 infection and HSES attitudes of the teenagers towards HIV infection/Aids, the study showed that 95.7% believed there is AIDS, 57.2% thought that AIDS was a new disease, 95.1% were scared of AIDS, 21.9% thought dying of AIDS was a punishment, 52.9% of school teenagers would feel comfortable to either learn or play together with someone with AIDS, 75.6% would feel ashamed if they had AIDS, 93.6% thought that AIDS was a serious problem in Malawi, and 86% said the use of a condom to prevent the spread of HIV was acceptable. On practices that put school-going teenagers at risk of contracting HIV/AIDS infection, the results revealed that 38.9% of the respondents either have a boy-friend, 35% have had sexual intercourse, and 25% of them had already used a condom.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Traditional Vaginal Agents: Use and association with HIV infection in Malawian Women.

• Assesses the prevalence of traditional vaginal agent in Malawian women and its association with HIV infection. Consenting, consecutive women presenting at the antenatal clinic were administered a questionnaire and screened for STD including HIV. The main data collection tool used in this study was a questionnaire. The questionnaire assessed socio demographic information, obstetric history, STD history, number of partners in the previous 3 years, and whether husbands had other sexual partners, use of traditional practices for treatment of vaginal discharge and itching and for vaginal tightening in the previous 3 years. All women were offered pelvic examination that included assessment of genital ulcerations and warts. Vaginal and cervical swabs were taken for identification of Trichomonas Vaginalis by wet mount and Neisseria gonorrhoea by culture. After pretest counselling and consent, blood routinely obtained for syphilis serology was tested for HIV-1 antibody. Sera twice reactive by enzyme-linked immunosorbent assay were confirmed by Western Blot analysis. All identified STDs were treated and all women received post-test counselling. Association between HIV serostatus and historic or laboratory variables were determined by contingency table analysis. Multivariate logistic regression analysis was used to identify variables that had independent associations with HIV infection. A total of 6796 women presented to the antenatal clinic for their first visit during the study period. Of these, 193 (3%) refused participation in the study. The 6603 study participants had a medium age of 24 years. Overall, only 119 of the women reported an STD in the previous 3 years. On physical examination, however, STD were found in 46% of the study participants. A total of 1502 (23%) women were HIV-seropositive. Multiple sexual partners (two or more) in the previous 3 years were reported by 29% of the women. Ten percent of the women, 13% HIV-seropositive and 9% HIV-seronegative (P<0.001), reported that their husbands had other sexual partners. Of the 6603 women consenting to participate in the study, 2322 (35%) reported using vaginal incision and 2222 (34%) reported using intravaginal agents for treatment of discharge and itching. A total of 1592 (24%) women reported using both methods for self-treatment, while 731 (11%) reported using vaginal incision exclusively, and 631 (10%) reported intravaginal agent use exclusively. Overall, 2953 (45%) women reported self-treatment with either practice. Women reported using the same intravaginal agents for both treatment and tightening. Data on the use of specific agents were available from 872 (98%) of the 886 women reporting their use for tightening and 694 (31%) of the 2222 for self-treatment. The reported treatment practices of vaginal incision and use of intravaginal agents were strongly associated with a history of most types of STD.

Location: CSR/COM , Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, , College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

Treatment of Women with Vaginal Discharge: Validation of the MOH Flow charts for Syndromic Management and Development of an Alternative Risk Assessment.

• This article validates the Ministry of Health and Population flowchart.Five hundred and fifty consecutive women presenting with genito-urinary complaints to QEC hospital were enrolled in the study. The study procedure was explained and all women were asked to sign an informed consent. Each woman was interviewed using a structured, pre-tested questionnaire administered in Chichewa which included questions concerning socio-demographic characteristics, health-seeking behavior, sexual behavior of the patient and her partner, current symptoms and contraceptive and STD history. Of the 550 women eligible for enrolment in the study, 107 (19.5%) had cervical infection with either N. gonorrhoea or C. trachomatis. Dual injection with both gonorrhoea and chlamydia was found in 1.3% of the women who were tested for both diseases (7/546). Of note, 64.9% (357/550) of women were diagnosed with an STD, defined as Trichomonas vaginitis, cervical infection, genital warts, genital ulcers and/or positive syphilis serology. 82.8% (92/534) of women were HIV seropositive. The most common symptoms identified on interview were vaginal discharge, (87.6%), vaginal itching (76.0%), unpleasant odor (51.3%), lower abdominal pain (48.9%), dysuria (48.7%) and dyspareunia (43.6%). In addition, 22.0% of women complained of genital ulcers and 12.5% complained of genital warts. The mean age of study participants was 25.1 years (range 14.48). Cervical infection rates were highest in the 21.24 years age group (19.9%) in under 21, 28.6% for 21-24 years, and 13.6% in 25 and older.

Malawian Young Women with HIV and their Health seeking Behaviour

• Identifies and describe Malawian young women with HIV and their health seeking behaviour in a holistic context incorporating an eco-cultural framework; to integrate this project with other health research in progress in Malawi. Participants in this study were young women with AIDS from a community in Malawi. Three types of qualitative field research methodologies were utilised:- questionnaires through first person interviews, key informant interviews and focus group interviews. The questionnaire was used as a base to begin collecting data, and included demographics and basic background about women with AIDS. The questionnaire was translated into Chichewa and field tested on a small opportunistic sample before being completed with revisions on the larger sample. Key informants such as primary health care workers were used to streamline questions that were more specific to women with AIDS who were seeking health care support. Information such as norms related to others and themselves seeking health care, roles specific to women, motivation, beliefs, feelings and emotions about seeking health care, barriers such as finances and distance to travel, and personal control were collected. An in-depth inquiry using open-ended questions and interviews was also completed to gain additional information missed or not captured in the questionnaires. One translator communicated all verbal responses to the primary researcher who immediately recorded the information manually. The study identified and described health seeking behaviour in young women with AIDS. The findings of this study were not clearly stated.

Location: NRC, National Research Council, P.O. BOX 30745, Lilongwe 3, Tel: 265-771 550/774 869, Fax:265-772 431/771 487-33,email: ncm@sdnp.org.mw 

A Study of people's attitudes towards family planning Programmes in Chintheche, Nkhata-Bay District, Malawi

• Report of a study conducted in Chintheche, Nkhata-Bay district to assess people's attitudes towards modern family planning programmes. The study found that people of Chintheche accepted the introduction of Banja La Mtsogolo family planning by 80% compared to 20% who were either not certain of what it would be or did not complete the questionnaire. 88% had knowledge of family planning, 11.2% were not aware of the method, 37.4% used a pill, 25.7% used condom, 22.7% used injectables and 14% used loop. The fertility rate was found to be 5.6 per woman, 15.1% of women under the age of 18 experienced early marriages.

Location: COM, , College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

A study of people's KAP towards Modern Family Planning Programme by Banja La Mtsogolo in Ntcheu.

The study findings show that 78.08% of the subjects interviewed were females while 21.91% were males. 81.61% of the respondents reported that they were aware of the pill while 37% were aware of the loop as contraceptive methods. Others 78.34% were aware of the injectables, 13.35% knew of diaphram and 6.55% were awa re of norplant, 27.7% were aware of vasectomy and 0.50% aware off natural methods. However, 5.79% states that they were not aware of any family planning method.

Location: COM, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

Report on Study of People's Knowledge, Attitudes and Practices of Modern family Planning Services in Six Villages in Mulanje, Malawi.

• The study was undertaken in order to identify the community demographic data, assess community's capability and willingness to pay for Banja La Mtsogolo modern family planning. Generally, the overall objective of the study was to obtain data which provide evidence to Banja La Mtsogolo of peoples' acceptance and willingness to participate in BLM's Modern Family Planning Programme in Mulanje District.

Location: COM, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

A Study on Attitudes of Nurse-Midwives towards Pain elief Measures Given to Women in Labour at Lilongwe Central Hospital and Queen Elizabeth Central Hospital.

• The study determined the nature of nurse-midwives attitudes towards pain relief measures given to women in labour. This was an exploratory descriptive study. Two major government hospitals, QECH and KCH, were used in this study. The two hospitals have big labour wards. The sample consisted of registered and enrolled nurse-midwives who had worked in the labour ward at least for one year. Thirty nurse-midwives, comprising of 10 registered nurse-midwives and 20 enrolled nurse-midwives were taken for the study. Data was collected using a 22 item questionnaire. The questionnaire had both open and close ended questions. The questionnaire was self-administered, and was administered during working hours for easy reach to the subjects. The findings indicate that all the subjects - 100% (30) were female. This shows that the majority of nurse-midwives working in maternity units were female. Thirty-three percent (10) of the total subjects were working in the labour ward. Seven percent (2) were working in antenatal ward, 16% (5) gynecological ward, 10% (3) nursery, 7% (2) postnatal normal. Seven percent (2) were working in postnatal abnormal and 20% (6) paying wards. This shows that the majority of subjects were working in the labour wards, seconded by paying wards. Out of 30 subjects, 20% (6) had worked in the labour ward less than one year, 66% (20) 1-3 years, 7% (2) 4-6 years while another 7% (2) had worked in the labour ward for more than 6 years. The results indicate that a higher percentage 66% (20) of the subjects had worked in labour ward for a period ranging from 1-3 years.

How can we help Adolescent Girls avoid HIV infection?

• Assesses knowledge, attitude, and behaviour of girls aged 10-18 years. Girls aged 10-18 years in two villages of Malawi were surveyed (District not mentioned). Female adolescents were also surveyed in 10 other villages. 258 girls aged 10-18 were recruited for the study. Focus group interviews were held, initiations attended and observed and interviews conducted with girls, mothers, grandmothers, and village leaders. The study revealed that although tradition dictates that young females abstain from engaging in sexual relations until being initiated by a traditional adviser following the initial onset of menses, many pre-initiation and pre-menstrual girls break tradition and say that they receive school fees and gifts in exchange for sex. While these village girls may know that AIDS can kill, most think that they are not at risk. Three hundred female adolescents were surveyed in 10 other villages. Seventy percent of the girls had sex before either initiation or menstruation with the average age at first intercourse of 13.6 years. Eighty percent of the girls had heard of AIDS and 14% thought they had a good or moderate chance of contracting it, yet they expressed a far higher perceived risk of contracting other sexually transmitted diseases. These benefits were obtained from radio, church, and word-of-mouth messages that AIDS is transmitted by easy partners, bar girls, and truck drivers, and from someone who looks very ill from AIDS. Fifty-six percent said they are often forced to have sex; 66% have accepted money or gifts for sex; and 75% would like help in learning how to convince a boy to use a condom. Grandmothers and other leaders tell girls about menstruation, hygiene, and illness, while sex education comes in messages through existing communication channels of grandmothers, other elder women, and peers could help correct false perceptions about HIV transmission and personal risk, and condoms need to be more available in villages as well as counseling on their use.

Location: COM, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Tel:677 245/291, Fax:674 700-33, com@malawi.net

Correlates of Teenage Motherhood in Rural Areas

• The objectives of the study were to provide insight on the phenomenon of teenage childbearing from the perspectives for the teenagers themselves, gather information which reflects cultural and social realities with respect to teenage childbearing in Malawi; provide information of the video "Voices of Young Mothers" so that the video can relate to and reflect the problems of being an adolescent mother. Three districts were selected to be sampled, Chitipa in the Northern Region, Ntchisi in the Central Region and Mangochi in the Southern Region. By having such wide geographical basis it was hoped to capture different attitudes based not only on geographical location but also on ethnicity and population density. One TA in each area was selected. Between 2 and 6 villages in each TA was sampled. There were three stages to the sampling: household census, structural questionnaire and focus group discussions. The study used both qualitative and quantitative data collection methods. However, the qualitative methods was mainly used to collect in-depth information. Structured questionnaires, focus group discussions and key informant interviews were the instruments used to collect data. A total of 1431 households were surveyed, 400 from Chitipa, 400 from Ntchisi and 631 in Mangochi. The structured questionnaire was administered to 221 teenage mothers and 221 actual and potential fathers. Ages for the teenage mothers were between 14 and 23 and fathers 14 to 27 years. Some were married without children, others with children; some single without children others with children. The average age among the young men surveyed was 20.04 years with 13.6% of the sample being 16 years or younger. Less than 1% of the sample were 14 years. The average age among teenage mothers was 20.24 years with 18.7% of the sample being 18 years or younger. Less than 1% of the sample came from the youngest age group. The three districts had distinct ethnic groups. In Chitipa the most prevalent ethnic group was Lambya with 32.1% of the teenage mothers and 32.8% of the potential fathers. In Ntchisi the prevalent ethnic group was Chewa with 94.7% of the teenage mothers and 96.7% of the potential and actual fathers. In Mangochi, it was Yao with 94.6% of girls and 98.4% men being from that group. Only 68.3% of the girls had ever attended school compared to 90% of the actual and potential fathers.

Location: CSR/CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

056 Hickey, C. (1999)

Factors Explaining Observed Patterns of Sexual Behaviour: Phase 2 - Longitudinal Study.

• This study aimed at creating better understanding of sexual behaviour and influence of culture on sexual behaviour and how individuals contribute to the sexual negotiations. The study is of a qualitative nature, that is addressing issues of attitudes, opinions and beliefs rather than quantifying particular behavior. It had a small sample. In-depth interviews were the primary method of data collection. Socio-economic information was gathered through a detailed questionnaire administered to all participants before the interviews began. The participants also filled out a calendar of sexual activity for each day of every month. The results show that men and women do discuss their sexual lives and experiences with their peer groups and age mates. Cross gender discussions are rare. The most common topics of discussion among both women and men are issues of contraception and STDs. However, among individual gender groups, there are some differences. The male respondents in the survey seemed more likely than their female counterparts to discuss the sexual act, however, their discussions are generally confined to their experiences with or of prostitutes. The women interviewed also discussed the sexual act, but within the parameters of seeking advice to satisfy a husband or lover, rather than judging or comparing various sexual partners.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Energy Intake, Iron and Zinc Nutrition of Pregnant Women in rural Southern Malawi.

• Assesses the energy and iron and zinc status of rural pregnant women in the Mangochi district of Southern Malawi. The sample for this study was comprised of rural pregnant Malawian women from Mangochi district. Jalasi area was selected as the research site. Jalasi Health Centre where the study was conducted is situated about 25km north-east of Mangochi Boma and the district hospital. The location is rural. A census was conducted in the eight major villages surrounding the health centre. The census covered 8040 persons in 1999 households. In this study, blood, hair, dietary intakes (via three 24 hr interactive recalls), selected anthropometric, health and demographic data were collected from rural women at 23.5 (= 2.5 weeks) gestation (n=152) and again at 32.9 (+ 1.7) weeks (n=84) gestation. The main occupation reported by 79% of adults in this area is farming. The average number of persons per household (4.0) is slightly less than the rural average for Malawi (4.4). The dependance ratio (children 0-14 years + adults > 65 years: persons 15-64 years) in the Jalasi area is 0.91, compared to 1.05 for all rural Malawi (NSO, 1994). Dietary intake data revealed low energy intakes at both 24 and 33 weeks associated with a low rate of weight gain (i.e. 0.13 kg/week); 20% actually lost weight during this period. Cereals provided the major sources of energy (72-75%), protein (58-61%) iron (44-51%), and zinc (60-62%) compared to only 4, 16, 10 and 20% respectively from animal products. Hence, median intakes of available zinc at both 24 (1.9mg) and 33 (1.8mg) weeks gestation were low, with 62% and 58% with phytate: Zn molar ratio > 15. Of the women 38% and 35% were at risk to inadequate intakes of Zn at 24 and 33 weeks gestation; corresponding prevalence estimates based on low plasma Zn were 43% and 47% and low hair Zn (<1.68 umol/g) 32% and 42% respectively.

Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

To what extent do Postpartum Mothers Perceive Support Pain Relief Measures Provided in Active Phase of Labour as Effective?

• The study investigates whether postpartum mother perceive the support pain relief measures provided in active phase of labour as effective and whether age, parity and level of education have an effect on them. A convenient sample of twenty postpartum women who had a normal vaginal delivery, had a live birth, and were between the ages of 15 and 35 years old were interviewed at the Lilongwe Central Hospital old Maternity Wing. The women were those who entered the labour ward in active phase of labour. The data was obtained using a demographic questionnaire with two parts. Part one had data on age, parity marital status, level of education, tribe and occupation. The second part of the questionnaire included twenty nursing support in labour items. The questionnaire was pretested using five subjects at KCN paying ward. The total number of subjects interviewed for the study was twenty. The age of the subjects ranged between 15 and 35. Twenty percent (n=4) were within the range 15-20, 40% were between 21 and 25, 30% (6) were between 26 and 30 and lastly, 10% (2) were between 31 and 35 years. Twenty percent (4) were primiparas whilst 80% (16) were multiparas. Twenty-five percent had planned pregnancies, 75% had non-planned pregnancies; 80% of the mothers had no education or education below standard 8 while 20% have education above standard 8. The affirmative pain relief measures are more effective in active phase of labour than the effective and aid supportive measures. Primiparas perceive support pain relief measures provided in active phase of labour as effective than multiparas. Women with a high level of education perceive support pain relief measures as effective than those with low level of education.

Report of a Free Lance Commercial Sex Workers: A KAP survey conducted between the months of November and December, 1994 in the city of Blantyre.

• The objectives of this work were to assess knowledge and attitudes towards sexually transmitted diseases including HIV infection; to plan intervention strategies of reaching these women with STD and HIV/AIDS ; to discuss with the women the possibilities of forming Single Mother Anti-AIDS clubs; to encourage the use of condoms among free lance commercial sex workers. The sample was composed of Commercial Sex Workers. The survey was carried out in the townships of Limbe, Bangwe, Mpemba, Lunzu, Ndirande, Chilomoni, Soche and Zingwangwa. These areas were selected because they are socially very active areas and are places where freelance commercial sex workers are found most. The survey used interviews and discussions using a questionnaire to facilitate the interviews. The survey found that commercial sex workers were within the ages of 16 to 20; a few were engaged in this business whilst married and most of them were literate.

Location: UNICEF, P.O. BOX 30375, LILONGWE 3[New Commercial Bank Building, 2^nd Floor, Capital City], Tel: 770 304/770 770/770 788, Fax: 773 162, email:unicef@unima.wn.apc.org or unicerf@malawi.net

Factors contributing to Premature Births in Women Delivering at Gogo Chatinkha Maternity Wing.

• Explores factors which influence an increased birthrate of premature infants in women who deliver at Gogo Chatinkha Maternity Wing. In this study, a descriptive research, approach was used. Subjects for this study were obtained from Gogo Chatinkha Maternity Wing at Queen Elizabeth Central Hospital in Blantyre. The target population consisted of all postnatal mothers who had delivered premature infants. The admission book was used to obtain the sample. Twenty subjects admitted during the past ten days of the study were chosen for the study. To obtain data on factors contributing to premature births, two instruments were used. These were interview schedule and checklists. The researcher completed the questionnaire as the respondent was answering the questions, and data obtained on review of charts and cards were also ticked on the checklist. A total of 20 postnatal mothers who delivered premature infants at the gestation between 28 and 37 completed weeks were included in the study. The mean gestational age of the women at the time of delivery was 31.4 (SD2.76) weeks; and the mean birth weight of the infants was 1.66 (SD.36kg). Premature births were higher in teenage mothers and they decreased with increased mother's age. A large percentage of the women did not have higher incidences of history of abortions and previous premature deliveries. Fifty-five percent of the women reported to have been engaged in strenuous activities during pregnancy while 45% had light activities throughout pregnancy. None of the 20 women reported to have been smoking or taking alcohol during pregnancy; and none of them reported to have had trauma during pregnancy.

Socio-economic Factors Affecting Adoption of Child spacing Practices Among Estate Tenants in Malawi: The Case of Mchinji Rural Development Programme.

• The study provides policy-makers with a better understanding of the constraints affecting the adoption of child-spacing methods at a micro-level i.e. the tobacco estate subsector. The sampling frame was drawn from the Estate Extension Service Trust, comprising of small estates (less than 20 ha), medium estates (21-60 ha) and large estates (more than 60 ha) in Mchinji RDP. In all, 15 randomly drawn estates were covered in the study. A total of 395 respondents were interviewed, randomly selected, 197 of whom were women. Two questionnaires were formulated for tenants and their spouses respectively. The questionnaire sought information on a number of issues, e.g. age at first marriage, household size, number of children alive/death, ideal number of children, etc. The findings indicate that estate managers/owners prefer married tenants and that the estate enters into verbal contractual agreement with the male tenant. The mean age of marrying for the tenants in the study area is 19 for the women and 23 for men. Children from the age of 10 assist their parents in tobacco production. The girls assist in looking after their siblings. Only 39% of the children attended school and all of them only attended lower primary school (STDs 1-5). The mean tenant household size is five persons. Nearly 50% of the tenants in this study reported that they had moved from another estate. A majority (79%) of the tenants and their spouses preferred a birth interval of between 2 and 3 years. 57% of the tenants and their spouses reported an average of ideal family size of between 4 and 6 children. 93% of the respondents had knowledge of at least one child spacing method. Only 40% of men used a contraceptive.

The Effects of Depressive Illness in the Mother on the Social Behaviour of the Pre-School Child.

• Examines whether having a depressed mother has any effects on the development of the pre-school children. The subjects included depressed mothers and their children. Mothers ages ranged from 16-50 years and children, either boy or girl, 2-5.5 years old. The study involved video-recordings of mother-child interactive play and experimenter-child interactive play. Mothers completed a questionnaire about the child's social behaviour at home. None pre-school children, each with a depressed mother and eleven children whose mothers had no psychiatric disorders were used for the study. There were few significant differences between children of normal mothers and children of depressed mothers in their play with their mothers. The differences observed were in non-verbal behaviour. In the experimental-child interactive play, children of depressed mothers talked and looked at the experimenter significantly less often and engaged significantly less often in solitary play than controls. The depressed mothers differed from control mothers in that they talked and played less often and watched their children more often. Logically related mothers and child behaviours tended to be correlated in the depressed group but not in the controls. Ratings of child behaviours were not related to a questionnaire measure of problem behaviours at home. However, the children of depressed mothers achieved higher scores on this measure than controls.

Location: CCL-MC, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

A Report on Factors that Influence Referral Default of At-risk Antenatal Women in Machinga District.

• The study's objective was to establish factors that influence referral default of at-risk Antenatal women. A multistage sampling method was used to obtain the study units. There were two groups of antenatal women, namely, those sampled from the admission books of the three referral hospitals and those sampled from eleven health centre catchment villages, service providers and selected elderly women (anankungwi). A descriptive cross-sectional study type was carried out in order to establish factors that influence referral default of at-risk antenatal women in Machinga District. Focus group discussions were used to obtain data. Interviews by structured questionnaire were also used. The results reveal that 32.9% of the at-risk antenatal women defaulted referral in Machinga District. 86.1% of the antenatal women delivered at a referral facility while 13.8% did not. Referral default is 32.9% in Machinga district though there is a possibility that it is higher than what it is now. Cultural beliefs such as witchcraft (37.5%) waiting for the paternal party to arrive before going for hospital delivery (75%) especially on first pregnancy play a role in influencing referrals. Other findings included heavy workload by service providers, lack of guidelines for referral, multiple women responsibilities, ignorance on genders and complications of an at risk pregnancy if not managed in time and existence of records and their utilization.

High Risk Behaviour in the Face of the AIDS Epidemic: The Case of Bar Girls in the Municipality of Zomba, Malawi

• This study sought to investigate from bar girls in the Municipality of Zomba why they became bar girls, how much they knew about HIV/AIDS and why they persisted in their high risk occupation. The sample comprised of commercial sex workers otherwise known as bar girls. The bar girls in the sample came predominantly from Zomba district (73.3%), some came from outside the district: four (13.3% came from Mangochi; two (6.7%) from Machinga; one (3.3%) from Blantyre; and one (3.35) from Chiradzulu. All except one ha d a rural background and their fathers tended to be subsistence farmers, small-scale businessmen, craftsmen or artisans. Data for this study were collected through intensive interviews with 30 bar girls from seven bars in the municipality of Zomba, over a period of two months: January - February, 1992. The study has shown that young women became bar girls in the Municipality of Zomba primarily out of economic necessity. It was discovered that most went into the occupation for economic security. They were all aware of the mode of HIV transmission and most knew someone who either had died of AIDS or presented symptoms of the disease. They persisted in this high risk occupation because it was potentially more renumerative than any employment they could get with their low academic qualifications. When service as a bar girl is combined with commercial sex, there is a good chance for a girl to improve her financial security, which is not possible in those jobs which command only minimum wages. The bar girls are constantly exposed to STDs of various types, including HIV/AIDs. An HIV positive bar girl would in a single month affect so many men who would, in turn, infect their own wives or girl friends.

Location: CSR/CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org 

065 Kishindo, P.

Condom Use: Rapid Assessment Study

• The pilot study was intended to examine issues of condom acceptability, preferred access, barriers for greater acceptance and misconceptions about efficacy. Four district, namely Blantyre, Lilongwe, Mangochi and Zomba were covered by the study. The study involved drivers, bar owners, bar girls/prostitutes, secondary school students, seasonal labourers and factory workers. A total of 19 focus groups were conducted, each composed of 9-13 people. Focus group discussions were adopted as a method of information gathering. All discussions were conducted in Chichewa, a national language. Proceedings were tape-recorded and notes were taken. Two guidelines were used, one for bar owners and one for the rest of the groups. The findings of the study revealed that there was a high level of awareness of AIDS is primarily transmitted through sexual intercourse with someone who is HIV-infected. Apart from AIDS, other STDs mentioned, in order of frequency, were gonorrhoea, syphilis and buboes (locally known as "mabomu"). According to the results of the group discussions, STDs were not regarded as a serious health problem in the various communities from which the participants came. Only in three groups did a participant suggest that AIDS might be a serious threat in their particular community. A number of ways for avoiding AIDS were mentioned, but no one particular method was mentioned as the most effective. Condom use as a method of STD prevention was mentioned in 13 out of 19 groups; abstinence from sex was mentioned in 4 out of 19 groups having sexual partner, in 9/19 groups; avoidance of promiscuous sex, in 7/19 groups. In one focus group made up of drivers, mention was made of inoculation with herbal medicine as an effective way of protecting oneself against STDs. However, the rest of the groups did not seem to be aware of this particular inoculation. Participants reported that when they contracted the STD they went to the nearest health centre or to a private medical practitioner in the first instance. Drivers preferred private medical practitioners, as these, in the drivers' view. offered greater privacy than public hospitals/health centres. Where modern medicine proved unable to cure an STD, they turned to traditional health practitioners. It is believed that certain STDs can only be treated by traditional herbal medicine. One such disease is "Chitayo" believed to be contracted when man has sexual intercourse with a woman who has just had an abortion. Only in 8/19 groups was it stated accurately that AIDS was caused by a virus. However, all groups were aware that a person may be an HIV carrier and still look healthy and that such a person may transmit AIDS.

Location: EC AIDS Project, P.O. BOX CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Knowledge, Attitudes and Beliefs on AIDS

• The main purpose of this study of this study was to provide information on how Malawian communities perceived AIDS/HIV infection and to provide information vital for designing, implementing and evaluating AIDS-related educational programmes. Specifically, the study was to assess knowledge about AIDS and HIV, its causation, manifestations, modes of transmission and people's susceptibility to it: to assess the attitudes and beliefs of communities about AIDS and the dangers it poses to individuals, their families and the community at large; and to assess perceptions about people who are HIV infected, have AIDS or are suspected to be at risk and how they should be treated, and finally to determine behavioral and life style changes that have taken place since information on AIDS began to be disseminated. The study was conducted in 8 districts of Malawi: Mzimba, Dedza, Dowa, Lilongwe, Chiradzulu, Mulanje, Thyolo and Zomba with a combined population of 3,890,558. The sample size for the study was 2000 people in clusters of 10. Fifty-nine percent of the sample were women while 41% were men. The two age groups (15-25 and 26-35) made up 68% of the sample. To collect the information that was required for the study, a survey method was used. The core questionnaire for the survey was developed by the World Organisation (WHO), but was translated from English into the national language (Chichewa), and adapted to the local situation. The Chichewa questionnaire was pre-tested at Somba village in Zomba district, southern Malawi, before a final version was made. The survey revealed that there was a high level of awareness of AIDS in the country. Ninety-three of the sample had heard about the disease. Eighty.4% percent of the sample recognised that there is so far no cure for the disease. Prostitution was identified as the major mode of transmission for the disease, and prostitutes were named most frequently as the category of people most likely to catch AIDS. The radio was identified as the source from which most was learned about AIDS, followed by the hospital/clinic/health centre. Although 61% of the sample thought they could catch AIDS, there was a high level of awareness that the disease could be avoided by adopting certain changes in behaviour. There was a remarkably positive attitude towards AIDS tests. Eighty-four percent of the sample said they would be willing to have an AIDS test if asked by a doctor and 81.9% would want to know the results.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Sexual Behaviour in the Face of Risk: The Case of Bargirls in Malawi's Major Cities

• This research investigated why young women became bargirls, how much they knew about AIDS, and why they persisted in what is regarded as high risk occupation. The study covered the country's three cities and one municipality: Blantyre, Lilongwe, Mzuzu cities and the Municipality of Zomba. A total of 540 bar girls in Blantyre, Lilongwe, Mzuzu and the Municipality of Zomba were interviewed for the study. None of the respondents was married at the time of the study, although 55 (10.2%) had been married at one time or another; and 64 (11.9%) reported having living children. They tended to be predominantly rural: only 16 (2.9%) reported they were born and brought up in the city. These 16 reported fathers in wage or salaried employment and business, while the rest reported fathers who were subsistence farmers, small-scale businessmen, craftsmen or artisans. The average age of the bargirls was 19 years, with an average of three years experience in the occupation. The highest level of education attained by bar girls was primary school leaving certificate, obtained after eight years of primary school. The lowest level attained was standard 5, that is five years of primary school. Thus, all the girls had some formal education and were literate and numerate to varying degrees. Lack of school fees was the single most frequently cited reason for failure to continue to higher levels of education.

Location: CSR/CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

Female Condom Acceptability Among Family Planning Clients of Blantyre.

• The main objective of this research was to determine the effects of counselling which specifically emphasize barrier methods, on the rate at which clients take home from family planning clinics male and/or female condoms; determine the effects of the introduction of female condom, in addition to the male condoms offered all new clients; on the overall prevalence and continuation rates of barrier contraceptive use; compare the rate and experiences of male and female condom use among clients who frequent the family planning clients; and compare the continuation rates of all the contraceptives offered in the three clinics. Three family planning clinics were selected which had the highest client attendance in Blantyre. Data was obtained from client records for one year. A total of 322 exit interviews were collected immediately after first time family planning consultations with all clients who took home male and/or female condoms and 294 follow-up interviews were made of the same clients from two experimental clinics. In those clinics the family planning providers were given a two-day training to update their contraceptive knowledge including the female condom and their skills in motivating and counselling clients with special emphasis put on providing clients with information on condoms. Counselling emphasizing barrier methods tended to increase the number of clients who took home barrier methods. A significantly higher rate (p = 008) of new clients took home barrier methods in each intervention clinic than in the control clinic. the introduction of the female condom, in addition to the male condoms offered all new clients did not increase the overall prevalence and continuation rates of barrier contraceptive use. In the intervention clinics there was statistically significant higher percent (p=.008) of new clients who took home barrier methods than those who had taken home barrier methods in the control clinic but there was not a significant different between the two intervention clinics. The continuation rates of all contraceptives was very low and only one client came back to the clinic to get more female condoms. By the end of the study year, only 8.3% of all clients from all three clinics returned. Male dominance between husbands and wives over sexual matters including contraception results in the need for the husbands" approval for the wife to use the female condom.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Quality of Family Planning Community-based Distribution Services in Malawi

• Provides comprehensive information on the selection, functions and quality of CBD services to use the findings for improving and expanding services, and as a baseline for future assessment. In depth case studies evaluating seven of the eighteen CBD projects. They were selected to include projects run by both governmental and non-governmental organisations and to provide an ethnic and geographic representation of the country. These were Marie Stopes and DHO (Nsanje), Project Hope (Thyolo), Mangochi DHO/MOH in the south; World Vision , (DHO/NFWC0, Central region and CHAM, SDA, Northen region. The case studies were conducted by a team of seven researchers using a combination of both qualitative and quantitative data collection techniques. All interviews were in-depth and lasted from one to two hours. There were 22 focus group discussions comprising a total of 258 participants; 66 observation of CBD agents' consultations with their clients; 134 interviews with clients, including those observed during consultations and unobserved; 79 interviews with CBD agents; 8 interviews with family planning services providers in referral clinics. The CBD projects were basically effective and contributed positively to the contraceptive prevalence rate in Malawi. The CBD agents exercised a major influence on villager's acceptance of contraceptive use. There were variations in the effectiveness and quality of the different CBD projects mainly due to differences in commitment of the CBD managers, etc. Sustainability continued to be a serious problem. There was a bias toward oral contraceptives in terms of availability and information given. More information was given on pills than any other methods and they were more consistently available than the other contraceptives. CBD records are not kept properly nor consistently, resulting in inaccurate national health statistics and an unreliable way to track clients for follow up for either possible medical problems or unnecessary contraceptive discontinuation.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Health Seeking Behaviour and Partner Notification by Clients with STDS in Malawi.

• Identifies social and cultural factors which function as a barriers to, and those which contribute positively to, partner notification by STD clients; determine factors during the process of the consultation with an STD client which encourage or discourage clients to notify their sexual partners; determine health seeking behaviour patterns of people who consider themselves to be suffering from an STD and determine the linkages between those pattens and partner notification and delay in seeking treatment; determine the role of traditional healers in STD client health seeking behaviour and partner notification. District Hospitals and one Central Hospital and the catchment areas were selected: one STD pilot site with high return of notified partners, one pilot site with low return, one hospital which is not a pilot site but where STD clients are treated and there is a high rate of STDS. These were Nkhata-Bay, Ntchisi and Lilongwe respectively. The study used an ethnographic approach and a multiple case design with in-depth interviews and observations. Data was collected focusing on three main subject, STD partner notification, STD health seeking behaviour and the role of the traditional healers. In-depth open-ended interviews lasting from one to three hours were conducted with 36 male and 31 female clients. Shorter, open-ended interviews were conducted with 7 STD clinic providers in the three hospitals. 6 Observations were made of the STD consultations at the three hospitals. Many informal discussions were held with key informants for background and contextual information. Findings demonstrated that an STD episode represented not only an illness which affected an individual's health but also social event with consequences which affected various other important aspect of their life. Health seeking behaviour involved up to 12 steps some clients followed all of them others didn't. Reasons causing delay to seeking treatment were enlisted and explained. The study identified many social aspects surrounding partner notification which influence if, how and why an index client will, indeed tell his or her sexual partner about the infection. There was much greater tendency for providers in STD pilot sites to tell their clients to notify their sexual spousal notification only and reluctance to discuss multiple-partner relations with both married and unmarried clients. STD clients had a tendency of seeking treatment from traditional healers as well as clinic and 70% sought second treatment from traditional healers in Nkhata-bay District.

Prevalence of Pregnancy-induced Hypertension in Women attending Antenatal Clinic at Gogo Chatinkha Clinic at Queen Elizabeth Central Hospital in Blantyre.

• This was a descriptive study. The independence variable for the study is PIH and the dependent variables included multiple pregnancy, age, parity, family history and hypertension, essential hypertension, diabetes mellitus. The study was done at Gogo Chatinkha antenatal clinic in Blantyre. Data were collected through antenatal cards of all pregnant women. A total of eighty-seven subjects were enrolled into this study for meeting the criteria. The demographic data were collected and documented. There were 1,511 antenatal cards which were reviewed and only 87 met the criterion for the study. Of these,20 were gravida 1 (22.8%); 33 were gravida 2-4 (37.8%); and 34 were gravida 5 or greater (39%). The largest group was in the gravida 5 or greater. Ten of the subjects were between the ages of 15-19 (11.5%), 22 between the ages of 20-25 (25.3%); 29 between the ages of 25-29 (33.3%); 20 between the ages of 30-34 (23%); and 6 were 35 years and older (6.9%). There were 60 (69%) non-working women and 27 (31%) were working women. All of them resided in urban areas. The findings show that of the 87 subjects, 23 were hypertensive at least at 36 weeks of gestation; and 64 were normotensive. Further analysis shows that of the 23 hypertensive women, 16 developed hypertension in pregnancy and 7 were already hypertensive on their initial antenatal visit to the clinic.

072 Lamba, C; Tucker, K.L.(1996)

Work Patterns, Prenatal Care, and Nutritional Status of Pregnant Subsistence Farmers in Central Malawi.

• Investigates the impact of agricultural and other work patterns and the extent of physical exertion on the third trimester and postpartum nutritional status of pregnant women; to measure the adequacy of dietary intake of pregnant women during their trimester in relation to energy expenditure; to examine and highlight other social, cultural and economic factors at the household and maternal levels that affect nutrition during pregnancy, to investigate and study the health care during pregnancy and to determine the birth weights of babies of the research subjects as a measure of the pregnancy outcomes. Rural women were enrolled in the study at approximately their fifth month of pregnancy. The final sample was chosen by selecting 23 villages from within district. Initially, the sampling would be in two stages, involving the random selection of clusters from through out the district. Structured and semi-structured questionnaires were used to collect data on (a) general household characteristics, (b) maternal characteristics and pregnancy history, © income, expenditures, and food production. The questionnaires were translated into the local dialect and pretested during the training period. Other methods used to collect data included direct observation and weighing of food intake, simultaneous observation of time use, anthropometric measurement of mothers and measurement of infant's birth weight. Blood was also drawn from the pregnant women for inter nutrient analysis. The mean age of the women in the sample was 26, 92% of them were married and had been married for an average of seven years. Only 4% of all the women were household heads. Twenty-three percent of the sample women had husbands who also had a second wife. Some of the single mothers were living with their own mothers or grandmothers and identified them as household head. They are poorly educated, with a mean of 2.7 years in school and a maximum education in the group of eight years. Their husbands were some what better educated. Almost all the respondents were participating in agricultural labour. Eighty-three (83%) of men and eighty (80%) of the women described themselves as farmers, Eight percent (8%) of the women reported that they were housewives, although most of them also participated in agricultural labour as evidenced by their activity records. Their housing is simple, with 76% living in mud houses. All but one family had a dirty floor and 92% had thatched roofs.

 Location: CSR/CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

A Needs Assessment of STDS, HIV/AIDS and Family Planning Service Delivery Through the Private Commercial Sector and Private Medical Practitioners in Malawi.

• The study identified and listed all registered commercial in-house clinics and private medical clinics that are currently providing FP services and STD management. This was a descriptive analytical survey, involving commercial and estate in-house, NGOs and private practitioners' clinics in two districts and one city, in the three regions of Malawi. The sample included all health facilities in the above categories. A total of 112 facilities were identified. A questionnaire was developed, based on the objectives of the assessment. A register of all health facilities, and all private practitioners in Malawi, was obtained from the Medical Council of Malawi. As per the MCM, there were a total of 112 private health facilities in the three selected districts, which met the sampling criteria mentioned above. Of these, 66 (58.9%) responded by returning filled questionnaires. The majority, 73 (65.2%) were owned by individuals. Blantyre district had the majority of these, 41 (56.2%), as well as a majority of the overall facilities 66 (58.9%). Clinical officers were the biggest single professional group with privately owned clinics, (n=42). 95.2% provided general medical health care; 57.8% offered STD screening and management, while only 28.6% reported to be offering FP services.

 Location: UNFPA, P.O. BOX 30135, LILONGWE 3, Tel: 771 444, Fax: 771 402-33, email: munfpa@malawi.net


074 Lema, V.M.; Thole, G. (1994)

Incomplete Abortion at the Teaching Hospital, Blantyre, Malawi

• This study was conducted in order to determine, among other things, their socio-demographic profiles, contraceptive behaviour as well as associated complications. The sample for this study comprised of women treated for incomplete abortion. A total of 444 women treated for incomplete abortion using the manual vacuum aspiration technique at Queen Elizabeth Central Teaching Hospital were interviewed by means of partially structured questionnaire to determine among other things their socio-demographic profiles, contraceptive behaviour, as well as associated complications. These formed 56% of all abortion cases seen in the department during the study period. During the course of interview, 27.1 % expressed desire to use contraceptive after treatment. There was strong correlation between previous use of contraceptives and future intentions. There was no serious complications noted amongst them. However, there were a good proportion of patients who went home with what would be labeled as anaemia clinically. The policy, programme , strategies for redressing the situation and service delivery implications of these findings are discussed.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

A survey of the characteristics of Family Planning Clients in Blantyre, Malawi.

• The objective of the study was to survey the social, biological and reproductive profiles and contraception awareness and previous use amongst family planning clients at the Central Teaching Hospital, Blantyre, Malawi. The sample comprised of family planning clients who were attended to between July 1 and December, 31, 1993. A total of 766 new family planning clients who were attended to between July 1 and December 31, 1993, were interviewed by means of partially structured questionnaires, to survey their ages, marital status, educational background, reproduction history, contraceptive knowledge and previous practice. The 766 clients formed 92.3% of all the new clients seen over the period July 1 and December 31, 1993. Most, (69.1%) were using contraceptives for the first time. Their mean age was 27 years, with a range of 15-43 years. Adolescents, (10-19 years) formed 10.1% and those aged >35 years were 17.1%. Ninety-one point three percent were married with the mean duration of marriage being 7 years. While 12.6% had no formal education, 29.7% had secondary school education and higher. The mean parity and living children were 3.6 and 3.1 respectively. The mean desired fertility was 4.5. Ninety-three point three percent of all clients had live births in their last pregnancies, majority of whom had delivered within the preceding 12 months. Contraceptive awareness was quite high, but only 30.9% had ever-used contraceptives before. However, there is need to review the family planning programme, with a view to incorporating it into the overall reproductive health care and setting targets such as addressing fertility regulation needs of adolescents.

Location: CSR/COM, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net; Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Social-demographic Characteristics of Family Planning Clients and their possible influence on Contraception in Malawi.

• The study determined the social, demographic and reproductive profiles of women seeking contraceptive services at the Central Teaching Hospital in Blantyre and their contraceptive awareness and previous practice. This prospective descriptive survey involved new family planning clients seen at the Queen Elizabeth Central Teaching Hospital, Blantyre. Seven hundred and sixty-six new clients were recruited and interviewed by means of partially structured questionnaire. Every new client who was seen, counselled and given/accepted a contraceptive method during this period was requested to participate in the study, after giving verbal consent. The information recorded included client's age, the highest level of education attained, marital status, menstruation, parity, number of living children, the end of the last pregnancy and its outcome, the desired fertility, contraceptive awareness, previous ever use of and future intended use. All these information as well as the method chosen or accepted were recorded on the appropriate questionnaire form. A total of 830 new clients were seen and counseled at the family planning clinic during the period of study. These give a daily average of 11 (10.6%) new contraceptive seeking clients. Of these, 766 (92.3%) were interviewed, and they formed the study group. Most (69.1%), of these women were seeking contraceptive services for the first time in their lives. Their ages ranged from 15 to 43 with a mean of 27 years. The modal age was 20-24 years. Adolescents (10-19 year olds) formed 10.1%, while those aged 35 years and above comprised 17.1% of the total. The majority (91.3%) of the clients were married, of whom their duration of marriage ranged from just one year to 27 years with a mean of 7 years. Thirty-four point five percent (34.5%) had been married for more than ten years. Sixty-six point three (66.3%) percent of the total study group were housewives. Their mean age at menarche was 15 years (n=732). Sixty-three point eight (63.8%) percent had attained menarche between 14 and 16 years of age. Of the total study group, 756 (98,7%) knew at least one method of family planning and where to go for the service. The method known by most women was the oral pill (86.0%), followed by the condoms, (45.5%), the IUCD (30.7%) and depro-provera (25.5%). Only 30.9% of the total had ever used contraceptives before. The methods used most were oral pills and condoms, (53.4%) and 25.4%) respectively.

Location: CSR/COM, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net; Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

The Effect of Mild Anaemia on the Productivity of Women Pickers on a Coffee Estate in Thyolo District, Malawi.

• Examines the relationship between haemoglobin and productivity; to estimate the loss of wage income attributable to anaemia; to investigate the impact of the estate wages on the economic welfare of women of reproductive aged women and their households. The sample comprised of women of reproductive age who were coffee pickers at a Coffee Estate in Thyolo district, Malawi. The study design was a cross-sectional survey from a cohort of non-pregnant women followed for a three week period. The sample size of coffee pickers was 235. Over nine working days interviewers visited the women at work and administered questionnaires containing questions about demographics, socio-economic status and other variables which were hypothesised to potentially influence the women's yield, anthropometric measurements and reported illness episodes for the past two weeks. The final study cohort was 217 women of the original 235. The age of the study population ranged from late teens to 60 years. The mean age was 28.06 years. Many were living without a partner: single 75 (34.6%), separated (0)41.5%) or widowed 14 (6.5%) Only 38 women (17.5%) of the study sample were married. Eighty (80) women (36.9%) reported that they were heads of their households. The mean haemoglobin was 12.533 g/dl (SD = 1.631). Thirty seven percent (32%) of women had haemoglobin levels below 12 g/dl. the WHO's cretaria for defining anaemia in non-pregnant women. The mean number of previous pregnancies was 3.176 (SD = 3.057). Almost a quarter of the study women had never been pregnant (24%) and almost half had had between one and four pregnancies (46%). The malaria bloodslides showed that 44 women (20.3%) of the study population were parasitemia positive in the last week of the study. Of these 44 woman, 10 reported symptoms of malaria and 3 had taken anti-malaria within the last two weeks.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

078 Lowenthal, N

Malawi Contraceptive Consumer Knowledge, Attitudes and Practices Survey

• Uses the results to refine or develop new messages to improve consumer's knowledge and attitudes about how to prevent AIDS and unwanted pregnancy by using condoms. A four-stage selection was used to develop the sampling framework for a survey of 1,075 respondents. Stage one consisted of the selection of two cities (purposefully) and four districts (randomly). The two cities of Blantyre and Lilongwe, including the peri-urban neighbourhoods, were purposefully chosen because they were part of PSI project focus. A sample was chosen among the sub population targeted by PSI's programmes, namely, sexually active men and women 14-45 years old living in low-income neighbourhoods of cities, trading centres and tea estates. All districts in each of the three geographical regions were listed, and one district each was randomly chosen in the north and central regions, and two districts were chosen in the southern region. The survey instrument consisted of a questionnaire with eight sections, each dealing with a specific topic. Each section has been analyzed across all respondents groups, to show the specific characteristics of each group, as well as their similarities and differences. The survey instrument was developed using the PSI standard condom consumer KAP protocol adapted to address Malawi specific reproductive health and AIDS/STD issues and obtain information about the impact of the PSI social marketing programme. Additional information was obtained through consultations with STAFH project, project Hope, Save the Children and Centre for Social Research. The survey instrument was prepared in English, Chichewa and Tumbuka the languages in which the survey was conducted. The summary of the findings reflect the analysis of data collected on 1,075 Malawians aged 14-45 years living in cities, trading centres and tea estates, and of lower socio-economic status. Fifty percent (50%) of this sample was drawn from urban cities, 40% from trading centres, and 10% from tea estates. Fifty percent (50%) of the respondents were male and 50% female. Sixty percent (60%) of the sample were adults (20-45 years) and 40% youth 14-19 years old). The majority of this population had a partial or complete primary school education (60% male and 68% female). A few had secondary education (35% males and 21% females). The majority of this population was upper low-income (63%), with males being slightly better of than females. Radio was the most common form of media available to this population (74%), with a higher percentage of males listening to it daily than females (84% males and 64% females). Ninety-nine percent (99%) of this population had heard of AIDS, and 98% reported believing it existed.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

AIDS: The Barriers to Behaviour Change.

• Reviews knowledge about AIDS/HIV infections; examine the cultural norms and values governing sexual relations and their implications for the future adoption of risk-reduction behaviours; determine some of the barriers to adopting HIV risk-reduction behaviour and to explore the possibility of using existing social networks for dissemination of AIDS education.

The sample consisted of bargirls/commercial sex workers, male civil servants, urban married women, rural married women/men, polygamously married men/women, clients of STD clinics, out-of-school youth aged 12-19 years, primary school youth aged 12-19 years and secondary school youth. The methodology used to collect data was focus group discussion (FGD) with a group of 6-10 people who were a representative of a target audience. The duration of the FGDs varied between 90 and 180 minutes. A recorder was used to take notes on the discussion. After the discussions the facilitator and the recorder wrote a one-page summary of their observations and impressions of the discussion. Detailed report was then written on the contents of the discussion using the recorder's notes. On whether sex is discussed openly in Malawi, the majority of youth believe that there is difficulty discussing sex openly in Malawian culture. The youth seemed to have a good knowledge of the costs and benefits of pre-marital sex. Four out of the 34 out-of-school youth in this study said they had not heard of AIDS. All other youth had heard of the disease. Only four primary school youth and six out-of-school youth (four girls) did not know what a condom is. The benefit of condom use identified were prevention of AIDS/STDS, avoiding pregnancy, and child spacing.

Keywords: AIDS/Commercial Sex workers/AIDS Knowledge/Condom Use/ Child Spacing

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Syphilis-associated Perinatal Mortality in Rural Malawi.

• Examines and quantifies the prevalence of and risk factors for acquiring Syphilis and its outcomes among a rural population of pregnant women. Consecutive pregnant women were enrolled and followed up throughout pregnancy and then once every two months for more than a year after delivery. The women received routine antenatal care, including monthly visits, tetanus toxoids, iron supplements, and malaria chemoprophylaxis, but there was no routine syphilis screening through the clinic system. Stored blood specimens collected during the antepartum period and at delivery as part of the malaria study were later tested serologically for syphilis. Sera were tested for syphilis. Reactive sera were diluted to an endpoint litre. Of the 3591 women who were enrolled and tested in the study, 130 (3.6%) had serological results that were consistent with active syphilis (VDRL/RPR test reactive, with litre $1:8 and reactive MHA - TPO assay), and 2968 (82.7%) had non-reactive VDRL/RPR tests and more than twice as likely to be illiterate (OR = 2.31; 95% CI= 1.03, 5.56 than those who did not have syphilis. Maltigraviudae with active syphilis were twice as likely to have had a home delivery (OR = 1.9; 95% CI = 24, 2.91 or to have a history of child death on the previous pregnancy (OR = 2.05 who had active syphilis were more likely to experience all types of still births as well as the early and late neonatal death even postneonatal death of their infants. Active syphilis accounted for 21% of the perinatal deaths and 8% of the infants deaths in the study population, as well as contributing to 26% of stillbirths, 11% of the neonatal deaths, and 5% of the postneonatal deaths.

Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

The effect of placental malaria infection on perinatal mortality in rural Malawi.

• Perinatal deaths (fetal or infant from 28^th week of pregnancy up to the seventh day after birth) occur as a result of adverse conditions during pregnancy, labour and delivery, in the first few days of life. Placental malaria is known to increase the risk of delivery of low birth weight infant, thus, potentially increase the risk of perinatal and infant mortality. To better understanding the relationship among the adverse events in pregnancy, including placental malaria infection, adverse condition in labour, and birth weight to perinatal mortality, there was an investigation of the perinatal mortality among cohort of infants born to rural Malawian women for whom placental malaria infection status and birth weight were documented. Among the 2,063 mother-singleton infant pairs, there were 111 perinatal deaths (53.8% percent death per 1,000 births). The risk of perinatal deaths increased as birth weight decreased. Risk factors identified per perinatal mortality among all infants excluding abnormal delivery (cesarean section, breech, or vacuum extraction), a history of a late fetal or neonatal death in the most recent previous birth among multiparous women, reactive maternal syphilis serology, nulliparity, and low socio-economic status. .

Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Immunoglobulin complex deposits in Plasmodium falciparum-infected placentas from Malawi and Papua New Guinea.

• Term placentas from 35 patients infected with plasmodium falciparum were obtained in Malawi and Six term placentas from patients infected with p. falciparum were obtained in Wewak, Papua New Guinea, Melanesia. The placental tissues were examined by microscopy and by an immuno-histologic method to compare the pathologic changes of placentas in the two malaria endemic countries. Using the number of parasitized red blood cells (PRBC) in intervillous spaces, pregnant women from Malawi with placental parasitaemia were categorized into three groups. In the high PRBC group (less than 20 percent, group 1), there was no deposition of IgE, in fetal blood vessels. In contrast, IGE was observed in fetal blood vessels of the intermediate PRBC group (1-10 percent, group 2) Andrew PRBC group (greater than 1 per cent, group 3). In all six placentas from Papua New Guinea women, deposition of immune complexes, including ice, was observed in the fetal blood vessels. All placentas with deposition of ice in fetal blood vessels showed no sequestration of malaria parasites in intervillous spaces. Our data that the amount of deposition of ice in the placenta from women infected with p. falciparum is inversely correlated with the degree of parasitaemia at the site.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

083 Makawa, J. A. (1995)

Factors Influence Utilization of Family Planning Services Among Adolescents in Basic Programme at Kamuzu College of Nursing.

• Investigates factors influencing utilization of family planning services among adolescents in the Diploma Programme of Kamuzu College of Nursing. The study addressed providers' perception and students' own perception on utilization of family planning services, psychological factors in relation to provision of family planning services to adolescents, physical availability of resources in the clinics and beliefs which influence the utilization of family planning services. A sample consisting of 42 subjects was obtained. Of the 42, 40 were student nurses drawn from first to fourth year, both male and females. There were 37 females and 3 males. The results of the study indicate that there is low utilization of family planning services among student nurses as a result of inadequate knowledge, lack of confidentiality by providers, lack of privacy in clinics, and students and providers failure to translate knowledge into practice.

Differential Impact of Health Talk Versus Peer Group Education on Risk Reducing Behaviour Towards HIV/AIDS in Bargirls in Malawi.

• The study was undertake to determine the differential impact of health talks versus peer group education on risk reducing behaviour towards AIDS/HIV transmission in bargirls. The total number of subjects in round one was 242 and in round two was 238 bargirls. The study was conducted in the Central Region of Malawi. A pretest and post test control group design was used. Indicators were established through interviewees on KAPB relating to AIDS, condom use, negotiating positions and clinical observation. Three different locations were involved in the study. One location was chosen as a control area. In the other two locations, interventions took place. Intervention one consisted of a two hour briefing on AIDS/HIV and STD prevention and condom use. Intervention two consisted of the introduction of peer group education through a four day peer group leaders training. One area had both interventions (1+11) and the other area had intervention one (1). In both groups condom distribution was organized and monitored. The impact of the interventions on risk behaviour and condom use was measured after a four month period between round 1 and round 2. Analysis of the data in round one and round two generally showed a close relationship between the modes of HIV transmission awareness and the methods of HIV prevention awareness. Knowledge of transmission was closely related to between 90 and 180 minutes depending on how much discussion and debate the topic generated. The findings of the study indicate that the majority of the participants who took part in FGDs are knowledgeable about AIDS and correctly identified many of the routes of transmission. However, it was evident from the discussions that participants possess little understanding of the relative risk associated with different routes of transmission. It was also found out that people are confused about how the virus is transmitted due to myths. The study findings further reveal that many people have a negative attitude towards condom use. Some of the reasons given for the negative attitudes include the widespread beliefs that condoms burst and become lodged.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Natural Family Planning (Billings Method): Factors Influencing its Utilization Among Couples of Lilongwe District

• Describes factors associated with the utilization of the Billings Family Planning Method and the experiences during the use of this method. A descriptive study was conducted to gain more understanding of the characteristics of individuals using the Billings method among couples of Lilongwe. All Couples, currently using this method were eligible to participate in the study. A non probability sampling procedure was used to recruit a sample of 30 women. A questionnaire, comprising of restricted and unrestricted responses was used in the collection of data for this study. A pre-test of the instrument was conducted on 6 women who were using Billings method at the time of the survey. More than three-quarters of the respondents (87%) were, at the time of the interview, married and living with their spouses. Prior to using Billings method of contraception, some respondents (43%) used other contraceptive methods, including both barrier and non barrier methods. The commonly cited were Depoprovera, Pills and Condoms, in that descending order. The majority (75%) of the subjects who had used other methods before, indicated that they had encountered problems such as signs of hyper tension and heavy and prolonged. Four women who used condoms complained of itching, rash and had reduced sexual pleasure. Out of the 30 respondents, 97% indicated that the method worked for them. Over half (57%) indicated they had been able to avoid conception.

Report on Evaluation of Traditional Birth Attendants Programme in Malawi.

• The study's aim was to determine the effectiveness (quality and quantity) of the TBA training programme on maternal and child health within the context of primary health care; to assess the deficiency and adequacy of managerial and supervisory aspects of the TBA programme; to assess the community's response to the trained and untrained TBAs and to explore other health areas where the TBA can be utilized within the context of primary health care. The sampling frame consisted of 487 trained TBAs, untrained TBAs identified in adjacent villages or outside the catchment area of trained TBAs and selected according to the criteria of selection for TBAs training. Hundred trained TBAs were randomly selected from the list of 487 TBAs trained between 1980-1984. All districts in Malawi were include, 100 untrained TBAs, 400 clients and 200 representatives of village organizations. For each selected trained TBA, an untrained TBA was identified as control during the course of the survey. Two main sources of data were used for the evaluation: review of National TBA Returns for 1984 and 1985 sample survey involving interviews of a sample of (a) trained TBAs, (b) untrained TBAs (c) clients of both trained and untrained TBAS (d) community leaders or officials in the villages where samples had been selected for trained and untrained TBAS and (e) trainers of TBAS. Five data collection schedules were developed according to the data required. These were questionnaires. The percent distribution of births attended in health institutions, (45%) by trained TBAS (7.8%) no trained health personnel (46.2%) by selected districts for which this information was available in 1986 and 1985. Forwarding of returns was not regular and consistent throughout the year which caused incomplete computing of national figures for births attended by trained TBAs.

Keywords: Traditional Birth Attendants/Training

A Descriptive Study of Utilization of Modern Child Spacing Methods by Women in Rural Areas: Knowledge, Attitude and Practices.

• Investigates the level of utilization of modern child spacing methods by women of Chagogo Village in Lilongwe District; to explore the knowledge, attitude and practices about modern child spacing methods which influenced the women's utilization of the methods. The study was descriptive. The women in Lilongwe rural who were in child-bearing age (13-49) who had once been pregnant were interviewed. The study was conducted in TA Chadza in Lilongwe District. The respondents were randomly selected. In this study, because the sample was from a community which could either read or write, interviews were used to gather data. Interviews were conducted at the subject's house and were done on a one to one basis. Responses were recorded on the interview schedule.74% of the respondents were married, 14% shared husband (polygamy), 4% were separated, 4% widowed, 2% single and 2% were divorced. The majority (54%) had no education. 86% of the subjects were housewives while only 14% were business women. The results of the study show that 68% of the women in this village know of at least one method of child spacing. The pill is the most commonly/widely recognized method (60%), followed by injectables (40%), spermicides and condoms (30%). Only 10% of the respondents had ever used these methods. At the time of the study, 4% of the respondents were using a modern method of preventing pregnancy, 2% were using a pill while the other 2% had tubal ligation for complete family planning.

Report on Knowledge, and Attitudes about Teenage Pregnancy in Malawi.

• The research intended to find out the significance of teenage pregnancy in Malawi especially in secondary schools; to find out socio-economic factors contributing to teenage pregnancy problem in Malawi; to find out the youth's attitudes towards contraceptives and knowledge about the teenage pregnancy itself; to get suggested solutions to the teenage pregnancy problem from the youth themselves and finally to formulate proper plan of action to solve teenage pregnancy problem and other related problems. The respondents were secondary school/DEC students aged between 13 and 19 who were systematically and randomly selected from forms 1 to 4 at each target school. The forms were categorised into junior forms 1-2 and senior forms 3and 4. In addition, the ages were also grouped: 13-16 from forms 1 and 2 and 17 to 19 from forms 3 and 4. The study was undertaken in all the three cities - Blantyre, Lilongwe and Mzuzu. The three cities were chosen to represent all the three regions of Malawi and also because the cities have schools close to each other and they were easily accessible. To come up with appropriate technique of data collection, a pilot survey was carried out in which oral interviews and questionnaire methods were tried. Data were collected from male/female and teenage students in 20 secondary schools in Blantyre, Lilongwe and Mzuzu cities, only 1940 were valid while 162 were null and void. The respondents were put in groups of 10-13 after being introduced to the objective of the study. Both male and female respondents said teenage pregnancy is the most serious problem faced in Malawi. About 805 of both male and female respondents know a friend who became pregnant in her teenage. Their responses on how the pregnant teenager felt, showed that negative experiences outnumbered the positive ones. Furthermore, about 80% of both male and female respondents know that there are reasons for avoiding teenage pregnancies. The most noted being loss of education and negative health implications on the mother and child.

Factors Associated with HIV-1 Infection and Estimation of new Infection in Pregnancy in Central Africa.

• The major goals of this study were to measure the current prevalence and estimate the annual incidence of HIV-I infection in young pregnant women from urban Malawi and to identify factors that were significantly associated with HIV-1 infection. The study was conducted in two urban centres of Malawi, Blantyre and Lilongwe and involved pregnant women seeking prenatal care. 461 consecutive pregnant women from two urban centres of Malawi were studied when they presented for prenatal care.Based on previous sero-prevalence in similar unselected populations, the estimated annual incidence of HIV seroconcersion in urban pregnant women ranged from 3 to 4% per annum between 1987 and 1989. Variables that were studied included history of STDS, blood was studied with the following in mind: history of STDS, history of blood transfusion, trimester at presentation, parity, history of premature births, spontaneous abortion, stillbirths, neonatal deaths and the number of living and dead children. The overall sero-prevalence of HIV infection in the two populations of pregnant women in early 1989 was 18.6% at QECH and 16.4% at KCH. At the QECH the HIV-1 sero-prevalence was 2% in mid-1985, 8% in mid-1987 and 18.6% in early 1989. At the KCH the HIV-1 sero-prevalence was 8% in mid 1987 and 16.4% in early 1989. In logistic regression analysis, HIV infection remained the only significant variable that was correlated with spontaneous abortion. This study shows that the point estimate for HIV-1 sero-incidence in pregnant women, which was about 3-4% per annum in the period 1985-87, is currently approximately 10% per annum in an urban centre in Southern Malawi. This study demonstrates a significant association between syphilis and HIV infection in urban sexually active women. The results confirm that other STDS particularly those associated with genital ulcers, are often present in individuals infected with HIV-1.

Location: COM, Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

090 Moitti,P.G.;Dallabetta,G.A.;Chiphangwi,J.D.; Liomba,G.;Saah, A.J. (1992)

A Retrospective Study of Childhood Mortality and Spontaneous Abortion in HIV-1 infected Women in Urban Malawi.

• This study was undertaken to examine the adverse effects of maternal HIV-1 infection on two outcomes of the previous pregnancy, as reported by the women:- Childhood mortality under age 3 and spontaneous abortion. Antenatal women in Blantyre, some 6605 consecutive women who presented to a large urban hospital (Queen Elizabeth Central Hospital) in Malawi for antenatal care were interviewed and tested for HIV-1 antibodies. All women who presented to the hospital for antenatal care were interviewed and tested for HIV Antibodies. Out of the 6605 women, 4229 (64%) were multiparous and 833 (19.7%) were seropositive for HIV-1. A history of under-3 mortality of the previous pregnancy was more common among HIV-1 seropositive than HIV-1 seronegative women (35% vs 15%, p<0.001). In the previous pregnancy, death of infants and children under 3 years was 77 and 119/1000 respectively for HIV-1 seronegative mothers, but increased to 171 and 292/1000 in infants and children under 3 for HIV-1 seropositive mothers. History of child mortality and reported symptoms of HIV-AIDS by infected mothers, except for history of tuberculosis which was reported more often by mothers whose child had died (4% v 1%, p<0.036).

Childhood Mortality and Adverse Pregnancy Outcomes in HIV-1 infected Women in Urban Malawi.

• Examines the adverse effect of maternal HIV-1 infection on two pregnancy outcomes: (1) childhood mortality under the age of 3 and (2) spontaneous abortion. The study sample comprised of prenatal women in an urban area (Blantyre). There were a total of 6605 women recruited in this study. 833 of 4229 (19.7%) multiparous women were seropositive for HIV-1. Reported under-3 mortality of previous pregnancy was more common in HIV-1 seropositive than in HIV-1 seronegative women (35% vs 15%, p<0.001). In the previous pregnancy, death of infants and children under 3 was 77 and 119 per 1,000, respectively for HIV-1 seronegative mothers, but increased to 171 and 292 per 1,000 in infants and children under 3 for HIV-1 seropositive mothers. (Overall children mortality (3 years) was 151/1,000 and infant Mortality rate was 94). History of child mortality was independently associated with positive HIV-1 serology, positive syphilis serology, low socio-economic status, young age and not having married. There was no correlation between child mortality and reported symptoms of HIV/AIDS by infected mothers, except for history of TB, which was reported more often by mothers whose child died (4% vs 1%, p<0.036). History of spontaneous abortion was reported more often in HIV_1 seropositive than seronegative women (15% vs 7%, p<0.001) and was independently associated with history of previous abortion, positive HIV-1 and Syphilis serology, history of STD and young age. In HIV-1 infected mothers cough and fever for more than 1 month were the only HIV-related symptoms associated with spontaneous abortion.

Location: CSR/NACP, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, National AIDS Control Programme, P.O. BOX 30622, LILONGWE 3. Tel: 265-726 540/724 262, Fax: 724 631

Timing of Excess Mortality in Children of HIV-infected African Mothers

• The objective of the study was to compare first year mortality of babies born to HIV-1 infected (SP) and HIV-1 uninfected (SN) urban women in Malawi. 1206 women at delivering at Queen Elizabeth Central Hospital and their babies 595 SP women and 611 SN women and their babies were recruited at delivery at a large urban hospital and followed-up regularly. Mothers of babies who died were interviewed about circumstances of death. Infants survival was analysed using babies of SP urban women were constantly at higher hazard for death than were babies of SN women. Beginning at five months of age the hazard of death decreased markedly for infants of SN, yet remained high (close to 1% per month) for infants of SP women. Further follow-up is necessary to provide more precise estimates of probability of death and specific diagnosis of death.

Location: NRC, National Research Council, P.O. BOX 30745, Lilongwe 3, Tel: 265-771 550/774 869, Fax:265-772 431/771 487-33,email: ncm@sdnp.org.mw 

The Role of the Nurse in the Promotion of Child Spacing in Malawi

• The purpose of this research was to ascertain the part played by the nurses in the promotion of child-spacing, this study was carried out. Sample selection was by non-probability sampling. Ten nurses involved in child spacing clinic in Lilongwe were recruited for the study. Data were obtained through a postal questionnaire sent to ten nurses involved in child-spacing clinics in Malawi. The findings for the study show that 80% of the staff involved in child-spacing were registered nurse/midwife, and 90% were registered nurse/midwife/public health nurse and another 90% enrolled nurses. Twenty percent indicated that clerical staff were part of the child-spacing clinic staff. Therefore, the results show that there are different staff categories in every clinic involved in child-spacing.

Socio-economic and Demographic Determinants of Family Size in Malawi: A Multivariate Analysis.

• The research was carried out to study the determinants of large families that are generally obtained in Malawi; to determine the amount of variation in achieved fertility (family size) that can be explained by the level of woman's education and to determine whether child survival is related to family size. The country was divided into four strata: Two rural and two urban. The first rural stratum, comprising 5,607 enumeration areas (EAS), covered the smallholder agricultural sector, while the second comprising 261 EAs, covered the non-smallholder agricultural sector consisting of agricultural estates, rural trading centres, forests etc. The first urban stratum, comprising 360 EAs, covered major urban areas of Blantyre, Lilongwe, Mzuzu and Zomba, whereas the second urban stratum, comprising 115 EAs covered the other urban areas in the country. In each stratum the EAs were arranged in descending order of size of the population and selection was done randomly with equal probability for each EA. A final selection of households was done on the basis of the three-stage design. The data for this work came from the Family Formation Survey conducted by the National Statistical Office in 1984. Four different questionnaires were used to collect various aspects of survey data. Questionnaire 1 collected data on the particulars of household member, including birth and death and household facilities. Questionnaire 2 was administered to women aged 15-49 years and collected data on marriage, fertility birth history, last pregnancy, current exposure to birth and attitude towards family size. Questionnaire 3 was administered to males aged 20-54 years and collected data on marriage and attitude towards family size and finally, questionnaire 4 collected data on the distance to the nearest community facility such as hospital, post office and primary schools. Results of the study indicate that when the effects of all other independent variables on achieved fertility are controlled for, current age of women is the most single important factor which is positively associated with achieved fertility, followed by her desired number of children. The other socio-economic factors, such as contraceptive use, urban residence, women's and husband's education, are not yet having an impact on fertility in Malawi. The results of this analysis suggest that, when all other factors are controlled for, education of females in Malawi is on the overall associated with higher achieved fertility.

Location: CC-DU, Chancellor College, Demographic Unit, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

095 Msokera, S.M.(1997)

A Study on Factors Influencing the Selection of Norplant as a Method of Family Planning.

• Explores factors that influence clients in selecting norplant as a family planning method in Lilongwe urban area. The study further investigated both prompting and hindering factors in client's selection of the method. The study was descriptive in nature. It was conducted in Lilongwe urban area. The target population was women who were then on norplant and those who had dropped the method. The sample size was thirty women, twenty women with norplant inserted and 10 who had norplant removed. Data were collected by means of using a questionnaire. The questions were close ended. A pilot study using the questionnaire was conducted. The mean age of participants was between 21 and 25 years. Out of the 30 women, 23.3% (n=7) were aged between 36 and 45 years. Only 6.7% (n=2) women were aged below 20 years. Eighty percent (n=24) of the respondents were married whereas the rest were either single, divorced, separated or widowed. Of the 30 subjects, 36.7% (n=11) reported friends as the main source of information about family planning methods, and 26.6% (n=8) reported relatives. The rest indicated health workers, husbands and literature. None of the participants mentioned radio as a source of information. All respondents reported of having at least one delivery. Of the 30 women, 16.7% (n=5) were multiparas. Only 10% (n=3) were grandmultiparas. All participants reported having knowledge about all family planning methods offered by Maternal Child Health.

Nutrition Education in Malawi.

• The study was ment to test nutrition knowledge of the mother and nutrition practices relating to under-fives, weaning and the family as a whole, as well as attitudes and beliefs about food; compare these findings in women who have received training and those who have not, in different parts of the country. The survey covered areas where intensive agricultural development projects had been introduced which were contrasted with areas outside the major agricultural projects. Selection of the survey areas followed a procedure of multi-stage area sampling. However, some constraints were introduced into sampling frame. Using the census list as a sampling frame, around 100 households in each area were selected for observation and interview. The main field survey was proceeded by a pilot in Zomba district. In the Survey villages, a sample population census was taken. Information such as name of the household, number of under-five children in the household and whether the mother had attended nutrition education course/talk or not. The main method used to obtain information for this survey were observation and interview using questionnaires. The results indicate that commercialization of food crops might be one of the most import causes of food shortages and therefore nutrition problems. Attendance of courses at nutritional centres, homecraft worker's groups etc., is very low even in those areas where there had been a resident Homecraft Worker or FHI. The three food groups has become more or less like a song. Taboos no longer play an important role to determine which foods may or may not be eaten by particular members of a household.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Final Evaluation of CPAR's Family Health Projects in Traditional Authority (TA) Chitukula, Lilongwe District

• Briefly, the ex-post evaluation of CPAR's activities in TA Chitukula was carried out to determine the extent to which the objectives of the Family Health Project have been achieved, assess the quality of designed activities, determine how and to what extent the project was able to adopt to changing needs/environment; determine factors that significantly affected the outcome of the project; assess the cost-effectiveness of the project, assess the replicability of the project and to make recommendations on the basis of the project strengths and weaknesses and the evaluation in general. A multi-stage sampling procedure was utilised in the evaluation of CPAR's Family Health Project. A list of all villages in T A Chitukula was made. There were 150 villages in total. A village being a geographical or organizational unit taken as a cluster. Out of 158 villages, (representing 10%) was chosen by systematic random sampling. Twenty-seven questionnaires were administered to women of child bearing age implying that about 30 women were interviewed in each village. A number of data collection techniques were used in this evaluation exercise, namely, literature review, in depth interviews, focus group discussions and household questionnaire. The household questionnaires was administered to women of childbearing age (15 - 45 years) in order to obtain quantitative data. The most important factor that has contributed to the success of Chitukula Family Health Project is that right from the beginning CPAR initiated a training process aimed at re-orienting people's thinking about development projects.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

An Analysis of the Child Spacing Methods in Malawi: An Overview.

• The study was conducted so as to find out the currently married women in the age group 15-49 years about their knowledge and use of contraceptives. The study design consisted of married women in the 15-49 age group. The methodology used was mostly cross-tabulation of raw data from the Food Security Nutrition Monitoring Survey. The situation in Malawi shows that both education and parity have a positive correlation with the use of contraception. Age at first marriage has not changed since 1984. The majority of women expressed the desire for family sizes of between 5 and 8 children. The knowledge of contraception was quite high (83%). The survey revealed that those practising some form of contraception relied on traditional methods. Women with no education did not use modern methods, while as educated women used modern methods. Of the modern methods, the condom and pill were the most popular. The period of post-partum sexual abstinence was between one and six months. Period of breast-feeding was around 19-24 months.

Condom Use in Marriage among Family Planning Providers in the Cities of Blantyre, Lilongwe and Mzuzu

• The overall objective of the study on condom use in marriage was to ascertain family planning providers' sexual attitudes, beliefs and practices and their readiness to adopt self-viour. Family planning providers were randomly selected from a list of family planning providers working in government and non-governmental health institutions in the cities of Blantyre, Lilongwe and Mzuzu. The family planning providers who were randomly selected were informed of the purpose of the study and requested to participate in the study. A focus discussion guide was used to obtain data on sexual attitudes, beliefs and practices related to condom use in the family. The guide was translated into Chichewa and Tumbuka. The guide had a total of 28 questions which focused on areas concerning matters related to sex and sexual practices in marriage, and about the use of condoms in particular. A total of three focus group discussions were conducted, one in each city. The focus group discussions had between 10 and 17 participants. A total of 42 participants were involved in this study, 17 from the city of Blantyre,15 from the city of Lilongwe and 10 from the city of Mzuzu. All participants were female.

Location: WHO/CSR, World Health Organisation, P.O. BOX 30390, Lilongwe 3, Tel:265-772 755, Fax:265-772 350-33, email:whomlw@mlw.net, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, 

Condom Use in Marriage Among Urban Workers and their Wives.

• The overall objectives of the study on condom use in marriage was to ascertain married couples' sexual attitudes, beliefs and practices, and their readiness to adopt self-protective ur. The sample was designed from 11 parastatal and 9 private organizations in the cities of Blantyre, Lilongwe and Mzuzu. These were randomly selected using the telephone book listing and those organizations which were willing to have their employees participate in the study were entered in the study. A listing of individuals in management, skilled and unskilled levels positions whose spouses were available in town was obtained. This listing was used randomly to select participants for the study. A focus group discussion guide was used to obtain data on sexual attitudes, beliefs and practices related to condom use in marriage. A total of 28 focus group discussions were conducted, 16 of male and 16 of female participants. The focus group discussion guide had a total of 28 questions which focused on areas concerning matters related to sex and sexual practices in marriage, about the use of the condom in ticular. A total of 238 participants were involved in this study. Of these, 53.4% (n=127) were male, and 46.6% (n=111) were female. Out of the total number of 238 participants, there were 97 couples. The age of participants ranged from 18-55 years. The majority were between the ages of 20-40 years, the age range which is sexually active and most vulnerable to HIV/AIDS infection. Fifty-three percent (n=67) of the males and 37.6% (n=42) of the females expressed that it was not difficult to discuss sex with their spouse, while 33% (n=42) of the males and 57.7% (n=64) of the females indicated it was difficult, especially when they were newly married. Sixty-five percent of the male and only 21% of the female participants had used condoms at one time or another. Fifty percent of the males who had ever used condoms had used them outside marriage, while the majority of the female participants had used the condoms in their marriages.

Location: CSR/CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

Reproductive Health Behaviour Survey Among College Students for the Future Model Project in Malawi.

• The objectives of the study were to assess knowledge, attitudes and utilization of reproductive health services by adolescents in various institutions. Sixteen focus group discussions were conducted, seven groups were of female students, six groups were of male students and three groups were a combination of female and male students. The study also looked at alcohol and drug abuse among ta re gathered through focus group discussions. From the results of the group discussions, there was not much difference between male and female ideas on the best age to start child bearing and their reasons were similar. On the ideal number of children a couple should have, some members of the three groups showed a preference number of children one ought to have.

Location: MOWYCS-M, CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Knowledge, Attitudes and Practices in Health Survey 1996

• The primary objectives of the study were to provide information on malaria prevention, family planning, immunization, management of childhood illnesses, marriage and partner relations and STD, including AIDS. The area sampling frame used for MKAPH survey consisted of the 8,652 enumeration areas (EA) from the 1987 Malawi Census. For this study, six sampling strata were identified with an urban and rural stratum for each of the three regions of the country. Four types of questionnaires were used for this study to collect data. The household questionnaire, the women's questionnaire, the men's questionnaire and the caretaker's questionnaire. Some elements of the standard DHS questionnaire were used in all four questionnaires. A total of 3,035 households were selected in the sample of which 2,839 were found to be occupied. Of these households, 2,798 were interviewed, yielding a household response rate of 99 percent in the interviewed households, 2,737 eligible women were identified and, of these, 2683 were interviewed yielding a response rate of 98 percent for women. The number of men identified was 2,861 of which 2,658 were successfully interviewed for a 93 percent response rate. The main reason for non-response among women and men was failure to be at home despite repeated visits to the households. The lower response rate among men as compared to women was due to the more frequent and longer absences of men from the household.

Location: CSR;NSO;CCL-MC, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net, National Statistics Office, P.O. BOX 333, Zomba, email:nso@sdnp.org.mw, nsolib@malawi.net, www.nso.com, Chancellor College, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

Demographic and Health Survey 1992

• Provides up-to-date information for policy-makers, planners and researchers that would allow guidance in the development and evaluation of health and population programmes. The sample of households was selected in two stages. First 225 Enumeration Areas (EAs) were selected from the 1987 census frame of EAs with probability proportional to population size. In the second stage, a systematic sample of households was selected, with the sampling interval from each EA being proportional to its size based on the results of the household listing operation. All women in these households aged 15-49 years were eligible for interview. Further, a one-in-three systematic sub sample of households was drawn, within which both eligible men aged 20-54 years and women aged 15-49 years were interviewed. There were both urban and rural samples. The major method for data collection for this survey was questionnaires. Four types of questionnaires were used. These included household, individual female, individual male and the health services availability questionnaire. The questionnaires were pretested before the actual data collection exercise. A total of 250 interviews were conducted. The findings indicate that fertility in Malawi has been declining over the last decade. At current levels a woman will give birth to an average of 6.7 children during her lifetime. Fertility is higher in the central region (7.4 children per woman) than in the northern region (6.7) or southern region (6.2). Over the last decade, the average age at which a woman first gives birth has risen slightly over the last decade from 18.3 to 18.9 years. Still, over one third of women currently under 20 years of age have either already given birth to at least one child or are currently pregnant. Fifty-eight percent of currently married women would like to have another child while 19% want one within the next two years. Thirty-seven percent would prefer to wait two or more years. Nearly one quarter of married women want no more children than they already have. Thus, 61% of women want either to delay their next birth or end childbearing altogether. Knowledge of contraceptive methods is high among all age groups and socio-economic strata of women and men. Early childhood mortality remains high in Malawi. The under five mortality rate currently stands at 234 deaths per 1000 live births.

Location: CSR/NSO, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Fertility and the Use of Birth-spacing Methods in Malawi: An Exploratory Study of Mzimba District.

• A thesis submitted in partial fulfilment for the Master of Arts degree in demography. The objective of the study was to identify major determinants of fertility in Mzimba district. The findings of the study showed that fertility differentials existed only by age at first marriage and also between women who were first wives and those second or higher order wives in polygamous marriages. The study revealed low levels of knowledge and use of birth-spacing methods among women in Mzimba Distric.

Location: CC-DU, Chancellor College, Demographic Unit, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org

Human Immunodeficiency Virus (HIV) among Pregnant Women: College Students and Commercial Sex Workers in Malawi, 1994.

• The study was carried out to obtain data on the prevalence of HIV infection among pregnant women, Commercial Sex Workers and first year student; estimate HIV infection trends overtime among pregnant women considered as a sentinel group for monitoring the spread of the HIV epidemic; and to make recommendations on future surveillance of HIV infection. Blood samples were drawn during visits to antenatal clinics. The samples were numbered as they were drawn and a list of names corresponding to numbered samples was kept. The samples were tested for HIV. Sera were collected from 2,944 pregnant women attending antenatal clinic at 20 rural, semi-urban and Urban health facilities. A total of 634 students were enrolled in the survey. Each student's serum was tested for HIV. Sera were collected from 437 Commercial Sex Workers at four sites. Age group, parity, previous history of STD, and duration of a commercial sex worker were collected at the time of recruitment. The Study results show that the majority of women (78.6%) were aged between 15 and 30 years. Parity up to 12 was reported. A quarter of the women had not given birth previously. Overall, the prevalence of HIV among the population was 17.4% (512/2942). Prevalence of HIV ranged from 3.0% at Thonje Health Centre in Salima District to 31.6% among pregnant women attending antenatal clinic at QECH in Blantyre.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Risk Factors Associated with Maternal Mortality in Lesotho, Malawi, Uganda and Zambia.

• The study determined the risk factors associated with hospital based maternal mortality in the four countries. The specific objectives were to determine the association between demographic factors, determine the association between maternal mortality; determine the association between obstetric, medical factors and maternal mortality and to determine the association between health service factors/environmental factors and maternal mortality. Case-control approach was used in this study where women who died as a result of complication of pregnancy and childbirth (cases) were compared with women who were admitted to the same institutions because of pregnancy and childbirth, but who did not die (control). Information about the cases was obtained from close relatives e.g. husband, mother, or sister (case-proxies), and to avoid bias when such information was compared to that obtained from the controls themselves, proxies were used to give information about the controls also (control-proxies). For every case, three control proxies were used. To validate the reliability of control proxy information, the first 500 controls were interviewed as well as their controls and theirs responses compared. A total of 288 maternal deaths were recruited as cases, and 864 controls. Approximately 30% of the deaths were associated with abortion, emphasizing the importance of abortion as a cause of maternal mortality in the region. Young teenagers (aged 17 years or less) and women aged 35 years or above were found to be at a high risk of maternal mortality. Single women of low parity (para 1-2) were at a higher risk than their married counterparts. The causes of death among single women were related to abortion. Lack of education or low levels of educational status was associated with greater risk of maternal death. Twenty-eight percent of all maternal deaths were due to abortion. Single women between deaths were due to abortion. Single women between age 25 and 29 years and parity 102 were found to be at higher risk of maternal death due to complications of abortion.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Study on HIV/AIDS awareness and the behaviour of youth in Malawi

• The principal objective of the study was to update baseline information on the knowledge, attitudes, and behavioural practices of youth in relation to HIV/AIDS and STDS. Specific objectives were to review current knowledge about HIV/AIDS infection and other STDs among youth in Malawi; to compare levels of knowledge of the diseases between three categories of youth in primary school, secondary school and out of school youth as well as between the two in as well as sexes, to determine knowledge, attitudes and practice concerning condom use in the three categories of youth; to examine the perception, norms and values governing the sexual practices of youth, and their implications for the adoption of risk reduction behaviours; to identify some of the barriers to adopting HIV/AIDS risk reducing behaviour and to identify sources of HIV/AIDS information trusted and accessed by youth. The study focused on the three official cities of Malawi: Blantyre, Lilongwe and Mzuzu. Individuals between the ages of 10 and 20 years were interviewed using a prepared questionnaire. Respondents were grouped as follows: primary school youth above 10 years old; secondary school less than 20 years old; out of school youth less than 20 years old. The study was undertaken in secondary schools, which were randomly selected, for students and market places for out of school youth. Data for this study were collected by using a questionnaire. A total of nine hundred (900) interviews were conducted, three hundred in each of the three cities, namely Blantyre, Lilongwe and Mzuzu. These interviews were conducted on individual basis. Forty (40) students from each school were interviewed and sixty (60) youth from each market place were also interviewed. The survey results show that the majority of the youth in the three study areas are open to discussing sex. Seventy nine point three (79.3%) percent of the respondents said they do discuss sex. However, more girls discuss sex than boys. About 83.1% of all girls in the study discussed sex, compared to 76.2% of boys. Secondary school students tended to discuss more than either primary school students or out-of-school youth. 87.1% of secondary girls and 86.55% of secondary school boys discussed sex. This was significantly higher than the numbers for primary school (77.3%) girls, 72.0% boys and for out-of-school youth (81.1% girls, 73.5% boys).

Location: CSR, CCL, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Malaria in Pregnancy in Blantyre: A Twelve-month Survey.

• This research was undertaken to study the prevalence and density of malaria parasitaemia in women attending Queen Elizabeth Central Hospital Antenatal Clinic and Labour Ward; to identify risk factors for malarial infection in pregnant women. Women attending Antenatal Clinic and Labour Ward. Women attending Antenatal Clinic and Labour Ward were questioned regarding age, obstetric history, and use of antimalarials during pregnancy. Finger prick placental and cord blood samples for measurement of haemoglobin and malaria parasitaemia were collected from consenting women. In antenatal women, malaria parasitaemia was found in 64% of women, with significant seasonal variation in prevalence from 55.7% in the late rainy season to 33.5% in May. Malaria parasitaemia was almost common and of highest average density in primigravidae and younger women. Moderate (1000-9999 parasites/ul) or high (>10,000/pi) parasitaemia was more frequent in primigravidas (4.0% of parasitaemic women) than secundigravidae (2.8%) or multigravidae (1.4%). At delivery, peripheral parasitaemia was found in 42% of women and placental in 31%. Parasite densities were generally low. Moderate or high parasitaemia was seen in only 5.9% of mothers and 10.0% of placentae and 2.9% of mothers and 3.6% of placentae respectively. Cord blood parasitaemia was detected in 10.0% of neonates. A history of use of sulphadoxine-pydmethamine (SP) was obtained in over 500 pregnant women, of whom 22% had taken 0 and 45% 1 dose, and the remainder at least 2 doses, as recommended. Women who had taken 2 doses of SP were compared to those with no SP.

Mitigatting in Malaria in Malawi Uncommon in Pregnancy and not Associated with Severity in Children.

• Investigates the frequency of rosette formation in malaria infections of children and pregnant women. 38 parasite isolates from pregnant women and 131 from children with severe or uncomplicated malaria were studied. Parasite isolates were either cultured from peripheral blood to trophozoite stage (159 isolates) or examined straight from placental blood (10 isolates). Mean percentage rosetting did not differ significantly between parasitised erythrocytes from children with uncomplicated malaria (n-59, rosetting 10.1" 12.4%). Rosetting by isolates from pregnant women (either attending antenatal clinic or in active labour) was significantly lower (n=27, rosetting 3.1" 4.2%). When parasites were examined directly from placenta without culturing, rosetting was low (n-10, rosetting 1.2" 2.3%). Parasites from pregnant women and particularly from placenta were more likely to be non rosetters (5/10 placental, 7/27 peripheral pregnant women, 3/59 mild malaria, 0/17 moderate and 2/45 severe malaria; p<O.Ol for placental isolates versus children, p<O.Ol for pregnant women versus children with mild or severe malaria). Rosette formation does not appear to be associated with severe malaria in childhood, and is infrequent in pregnant women in Malawi. Parasites sequestered in the placenta show little rosette formation.

110 Sangala, V (190)

Maternal Deaths in 1990 at Kamuzu Central Hospital

• Analyses maternal deaths that occurred at the Kamuzu Central Hospital in Lilongwe during the year 1990. This was a retrospective study. The records of all maternal deaths that take place in the Bottom hospital are kept aside by the ward clerk. The gynaecology ward has a 'death book' that is filled in by the nurse on duty when a patient dies. Through this book the case files of the patients were traced. As much information as possible was then extracted from the notes. The records of 74 maternal deaths were available. The patient's age was either unknown or not recorded in over half of the cases, however it is of interest that 10 women were aged between 16 and 19 years. Of these 4 were indirect deaths and 6 were direct deaths. Analysis by parity showed 21 deaths were para 1, 28 were para 2-5, and 17 were para 6-10. Parity was unknown in 8 cases. Only 23 women (38%) were documented as having received some antenatal care.

111 Simbota,M;Mbvundula,RG;Mtimaukanena, I; Mhango, F.

Factors that Effect Performance of Nurses-Midwives in Maternity Units of Midwifery Training Hospitals in Malawi.

• Investigates the factors that effect performance of nurse-midwives in maternity units of all midwifery training hospitals in Malawi. Using a descriptive design, a total number of 94 nurse midwives and 97 postnatal mothers were sampled. To collect data for this study, interview schedules, checklists, and focus groups discussions were used. In general, the findings showed that performance of nurse midwives is greatly affected by the following factors; unavailability of major midwifery guidelines; increased workload; unavailability of effective patient communication system and shortage of supplies. However despite the unsatisfactory working conditions, the nurse-midwives perceived themselves competent in midwifery skills and the postnatal mothers received the care provided by nurse-midwives as good.

HIV-1 Infection Among Women of Reproductive Age in a Rural District in Malawi.

• The study was carried out to determine HIV-1 prevalence in pregnant women attending antenatal clinics in a rural district in Malawi, and to estimate the rate of HIV-1 infection in districts among women of reproductive age. A cross sectional survey was conducted from 1987 to 1990 of women enrolled at antenatal clinics at four sites (two towns and two villages. Questionnaires were administered and sera screened at delivery. Population infection estimates were based on national census survey data. The findings of the study were that seroprevalence rates in pregnant women in rural areas were intermediate between rates in villages and previously documented rates in rural and in cities in Malawi. Although village sites had lower seroprevelence rates, they accounted for over half of the estimated HIV-1 infection in child bearing women in this district.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

113 Shultz, L.J.;Steketee, R.W.;Chitsulo,L.; Macheso,A.;Kazembe,P; Wirima, J.J.

Evaluation of maternal practices, efficacy, and cost-effectiveness of alternative antimalarial regimes for use in pregnancy: Chloroquine and Sulfadoxine-pyrimethamine.

• With the knowledge that an efficacious antimalarial administered to pregnant women would markedly reduce placental malaria and its associated risk of low birth weight (LBW), investigations were conducted to identify an antimalarial regimen practical for nationwide implementation through the antenatal clinic (ANC) system. Maternal practices, including ANC utilisation and malaria treatment and prevention during pregnancy were evaluated as part of a national malaria knowledge, attitudes, and practices survey. A second study was conducted to evaluate the efficacy and cost of selected alternative antimalarial regimens. Women in their first or second pregnancy were placed on Chloroquine (CQ) treatment (25mg/kg) followed by CQ (300mg) (CQ/CQ); sulfadoxine-pyrimethamine (SP) treatment followed by CQ (300mg weekly) (SP/CQ); or SP treatment during the second trimester and repeated at the beginning of the third trimester (SP/SP). With 87 percent of women attending ANC two or more times during the pregnancy, most pregnant women in Malawi could be reached with an antimalarial intervention. Among 159 women in their first or second pregnancy receiving CQ/CQ, SP/CQ, and SP/SP, placental malaria parasitaemia rates were 32 percent, 26 percent, and 9 percent, respectively (p=0.006, chi-square test). The SP/SP regimen was also markedly more cost-effective in preventing infant deaths, costing $75 per infant death prevented, compared with $481 for SP/CQ and $542 for CQ/CQ. These investigations suggest that a regimen consisting of two treatment doses of SP during pregnancy is an efficacious cost-effective intervention to prevent placental malaria, and LBW-associated mortality, that can be delivered to pregnant women through ANC in setting similar to those found in rural Malawi.

Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

The Efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental plasmodium falciparum among pregnant women in Malawi.

• It defines an effective and deliverable antimalarial regimen for use during pregnancy, pregnant women at highest risk of malaria (those in first or second pregnancy) in an area of Malawi with high transmission of chloroquine (CQ)- resistant plasmodium falciparum were place on CQ and/or Sulfadoxine-pyrimethamine (SP). Of 38 pregnant women who received CQ treatment followed by weekly CQ prophylaxis (CQ/CQ) for at least 45 days prior to delivery, 32 percent had placental malaria infection, compared with 26 percent of pregnant women who received a two-dose SP regimen (SP/CQ) and only 9 percent of 71 pregnant women who received a treatment dose of SP regimen (SP/SP; given once during the second trimester and repeated at the beginning of the third trimester) (p=0.006, by chi-square test). During the peak transmission season from April to July, 47 percent of the women who received CQ/CQ had placental malaria infection at delivery, as compared with 37 percent of the women who received Sp/CQ, and 10 percent of women who received SP/SP (p=0.004, by chi-square test). Among women in their first or second pregnancy, two treatment doses of SP were highly effective in decreasing the proportion of women with placental malaria infection at delivery.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Antimalarials during pregnancy: a cost-effectiveness analysis.

• Antenatal clinics provide an avenue for interventions that promote maternal and infant health. In areas hyperendemic for plasmodium falciparum, malaria infection during pregnancy contributes to low birth weight, which is the greatest risk factor for neonatal mortality. Using current data and costs form studies in Malawi, a decision-analysis model was constructed to predict the number of LBW cases prevented by three antimalarial regimens, in area with a high prevalence of Chloroquine (CQ) - resistant malaria. Factors considered included local costs of antimalarials, number of ANC visits, compliance with dispensed antimalarials, prevalence of placental malaria, and LBW incidence. For an hypothetical cohort of 10000 women in their first or second pregnancy, a regimen consisting of one dose of sulfadoxine-pyrimethamine (SP) in the second trimester followed by a second dose at the beginning of the third trimester would prevent 205 cases of LBW at cost of US$9.66 per case of LBW prevented. A regimen using a treatment dose of SP followed by CQ 300mg (base) weekly would prevent 59 cases of LBW at a cost of $62 per case prevented, compared with only 30 cases of LBW prevented at a cost of $113 per case when the regimen involves initial treatment with CQ (25mg/kg) followed by CQ 300 mg (base) weekly. In areas hyperendemic for CQ-resistant P. Faciparum, a two-dose SP regimen is a cost-effective intervention to reduce LBW incidence and it should be included as part of the antenatal care package.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Traditional and Modern Methods of Child Spacing in Malawi: Knowledge, Attitudes and Practice.

• Aimed at confirming the existence of traditional methods of child spacing; to determine the extent of attitudes towards and knowledge and practice of traditional methods of child spacing in Malawi; to identify dominant socio-economic and demographic factors responsible for knowledge, attitudes and practice variations in different parts of Malawi in respect of traditional and modern methods of child spacing. The study was based on sample enquiry. The sample contained spatial dispersion and substantial variations in demographic, social, cultural, etc., factors of population in Malawi. A two stage sampling design was employed. The selection was purposive at the first stage and random at the second. To gather data two questionnaires were used. One for females and one for males. The questionnaires were first pilot tested by final year demography students of Chancellor College. The pilot testing was done in both rural and urban areas of Zomba district. The main field survey however, was conducted by enumerators, assisted by supervisors. The study covered Blantyre, Chiradzulu, Lilongwe, Mchinji and Rumphi districts. The survey covered 2,892 males and 3,043 females. The male sample included 784 and 2,098 males from rural and urban areas respectively. Whereas the female sample included 1,114 and 1,929 females from rural and urban areas respectively. The male sample was more urbanized than the female one. The difference between the female-male urbanization rates for the sample was 5%, the respective rates were 16.3% and 11.3%. The sample included females aged 15 to 54 years and males aged 20 to 59 years. The sample at the time of the survey consisted of 78% married and only 11.8% never married females. Widowed females accounted for only about 2% of the sample. Almost one-third of females in the sample had no education as opposed to about 13% for males. About 46% of males and 38% of females reported farming as their main economic activity.

Location: CC-DU/CSR, Chancellor College, Demographic Unit, P.O. BOX 280, ZOMBA, Tel: 265-524 222, Fax: 265-522 046, 265/522 578, email: ccadmin@unima.wn.apc.org, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

HIV-1 Infection Impairs A Pregnant Woman's Acquired Ability to Limit Plasmodium Falciparum Infection.

• Examines the association between HIV-1 and P. Falciparum in pregnant women enrolled in a malaria chloroquine chemoprophylaxis study in rural Malawi. Between September, 1987 and July, 1989, a total of 2,946 pregnant women were enrolled into a malaria chemoprophylaxis investigation at their first antenatal clinic visit at four sites in Mangochi district, Malawi, a setting with high malaria transmission. After obtaining informed consent, the women were given a standard questionnaire, weighed, measured and had blood drawn to determine malaria parasitemia, haematocrit, and HIV-1 seropositivity. The women were then placed on a malaria chemoprophylaxis regime using chloroquine (CQ). They were placed on one of the three CQ regimens: (1) weekly CQ (300mg); (2) an initial treatment dose of CQ (25mg/kg given in divided doses) followed by weekly CQ (300mg); or (3) monthly treatment doses of CQ (25mg/kg in divided doses). Thick blood smears were stained with GIEmsa and examine for malaria parasites and white blood cells in continued fields. Serum was collected for HIV-1 test at the time of delivery and tested for HIV-1 antibodies using enzyme-linked immunosorbent assay (ELISA). Parasitemia was detected in 46% of 2,946 women at enrollment and 19.1% at delivery; HIV-1 seroprevalence was 5.5%.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

The Effect of malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi.

• While there is broad evidence for the adverse effects of plasmodium falciparum infection in pregnancy and the World Health Organisation recommends preventive strategies, there is remarkedly reduce efficacy in sub-Saharan Africa of the most widely available, affordable and used antimalarial drug for chemoprophylaxis-chloroquine (CQ). During 1987-19990, pregnant women were studied in an area of high malaria endemicity in rural Malawi to compare the efficacy of CQ (the drug recommended by national policy) with mefloquine (MQ, a relatively new and highly effective antimalarial) in preventing low birth weight (LBW) due to premature and intrauterine growth retardation (IUGR). Among 1,766 women monitored during at least their last 6 weeks of pregnancy with observed ingestion of their regimen and facility delivery of a live born singleton, factors, their babies had a mean SD birth weight of 2905 positive or negative 461 gm and 16.8 percent had LBW. In a motivariate analysis, factors significantly associated with LBW included: first birth (odds ratio [OR]= 4.27), female infant (OR=2.92), maternal human immunodeficiency virus infection (OR=2.66), low maternal weight (OR=1.95), and placental blood p. falciparum infection (OR=1.71). Factors significantly associated with IUGR-LBW included first birth, female infant, low maternal weight, and placental malaria. Factors significantly associated with preterm-LBW included maternal syphilis infection, umbilical cord blood malaria, first birth, low maternal weight, and female infant. Use of an effective antimalarial (MC) was protective against LBW through its effect on reducing placental and umbilical cord malaria infection.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Trends of HIV-1 and Sexually Transmitted Diseases among Pregnant Women in Urban Malawi.

• Examines trends in the prevalence of HIV-1 and sexually transmitted diseases (STD) among pregnant women in urban Malawi. Serial cross-sectional Surveys. Three major surveys were conducted in 1990, 1993 and 1994/95 to determine the prevalence of HIV and STDs. In the 1990 and 1993 surveys, consecutive first-visit antenatal women were screened, and in 1994 all women giving birth at QECH, Blantyre for a period of six months were tested for HIV. Women surveyed in 1990 and 1993, were examined for STDs and HIV. A subset of women tested for HIV in 1994 were examined for STDs in 1995 at least five months post delivery. Testing for HIV and STD was done after counselling and informed consent had been obtained. Unlinked, anonymous testing was also conducted on smaller sample of consecutive, first-visit antenatal women between 1995 and 1996, to provide annual seroprevalence data, standard procedures for testing HIV and STDs were used. HIV seroprevalence rose from 2.0% in 1985 to 32.8% in 1996, a sixteen fold increase. The trend of HIV increase among pregnant women in recent years was not significant. The highest age-specific HIV prevalence was in the age group 20-24 years in 1990,

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Condom Use Among Infected and Uninfected Women in Malawi.

• The study compared reported condom use in two populations of urban women in Malawi who were surveyed four years apart, to analyse the trend of condom use in a prospectively followed female population, and to evaluate the reliability of self-reporting of condom use and sexual activity using laboratory diagnosis of incident STDs. The Study population was constituted of women attending the antenatal clinic of Queen Elizabeth Central Hospital (QECH) in Blantyre. All women presenting to the antenatal clinic over a 12 months period in 1989 and a 5 months period in 1993 were screened for HIV-1 antibodies. HIV seropositive and seronegative women from both periods were subsequently enrolled in prospective studies. A subset of the population screened in 1989 was followed prospectively for 24 months and studied for reported condom use and sexual activity. At enrollment a structured questionnaire was administered to collect information on demographic, medical and obstetric history. After enrollment women and their children were seen at the study clinic every six months. At each visit women were asked specific questions about knowledge and use of condoms, and sexual activity after delivery and a physical examination was conducted on mother and child. Women and their partners were offered counseling and treatment for STDs. A total of 6603 pregnant women were screened for HIV between October, 1989 and October, 1993. Of these, 1378 (679 HIV seropositive and 687 HIV seronegative) were enrolled at delivery in the first follow-up study. 2103 pregnant women were screened for HIV between January and May 1993. Of these, 1011 (246 HIV seropositive and 765 HIV seronegative) were enrolled at delivery in the second follow-up study. A threefold overall increase in any condom use was reported by the women surveyed, from 5.6% in 1989 to 17.5% in 1993 (P=0.001). Intermittent condom use was higher at both time points among HIV seropositive than seronegative women (P=0.001). Consistent condom use was reported by less than 1% of the women, regardless of HIV infection status, and increased significantly, between 1989 and 1993, only in HIV seronegative women (P=0.02). The proportion of women reporting sexual intercourse was lowest in the first six months postpartum and reached a pleatence by one year, among both HIV seropositive and seronegative women, but at each visit, the proportion of women reporting sex was higher among seronegative women.

Location: CSR;COM, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net: Location: COM,College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

An Intervention to Reduce the Risk of Mother-to-Infant HIV Transmission: Results of Pilot Toxicity Study.

• The primary objective of this study was to determine safety and acceptability of the chlorhexidine washing prior to initiating a large clinical trial addressing the efficacy of this procedure. Part of the pilot study addressed evidence for efficacy in reducing bacterial colonization with Group B streptococcus, a beneficial effect seen in European women. Forty women were enrolled consecutively in each of four groups. Group one non-pregnant women of known HIV status attending a maternal-infant health clinic, received the chlorhexidine wash. Group two, three and four, all pregnant women, received no intervention, Saline wash or hlorohaxidine wash, respectively. At each stage, data were reviewed for complaints or complications before proceeding to the next enrolment group. All women were evaluated with an enrolment questionnaire, a speculum examination pre-intervention (if any) during which specimens were obtained, at a re-evaluation at 24 hours, again with a speculum examination and collection of specimens. Sera were obtained for HIV and syphilis (RPR) testing. Cervical Swabs, and vaginal mounts and lavage were collected pre- and post-intervention. Women who failed to re-appear for the 24 hours evaluation were sought by active outreach tracing to assure full information about the results. Laboratory studies were done only on pregnant women to establish HIV antibody status, syphilis serology, Group B streptococcus carriage, and tests for T. vaginalis, yeast, N. gonorrhea and bacterial vaginasis. Of the 160 women enrolled in the study, 153 re-appeared as scheduled on the following morning. Six others (4 in the non-pregnant group) were successfully located and re-evaluated in the afternoon of the scheduled visit. The address provided in the inadequate to find one subject (in the saline group) but she reappeared at one month and had had no problems. The HIV prevalence among the 120 pregnant women was 30% and the syphilis reactivity (RPR test) was 9.5%, both typical of the rates found in women attending the antenatal clinic at QECH. None of the women had spontaneous complaints about any procedure, either at the time of, or at 24 hours after the procedure. Several offered favourable comments. In response to an open-ended questionnaire, 25 (15.7%) women stated that the procedure used relieved their vaginal itching, one stated it had not changer her itching, and none stated it caused itching. Other complaints specifically sought in the questionnaire included discharge, swelling and/or bleeding. There were no differences between the groups.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

The Relationship between Couple Communication in Machinga District, Southern Malawi.

• Households were randomly selected with probability proportional to the size of the village. This study used information from 361 matched husband-wife pairs. At each selected household, if a wife and husband were present who met the specified age criteria (for women, 13-45; for men, 19-49) they were interviewed separately and privately. Questionnaire was used to collect data. The questionnaire incorporated demographic questions from the Malawi Demographic and Health Survey, as well as questions intended to gauge the amount of communication and cooperation between couples. At the time of the study, only 55% of the women and 43% of the men had been married once only. For respondents in the older age brackets, less than one-third were still married to their original partner. Most of the marriages had been arranged: less than 20% of the respondents reported that they were friends with their present spouse prior to marriage. Wives' knowledge about their husbands was limited: about one-third did not know his educational level and 4% did not know even his first name. Approximately 15% of the couples were polygamous. About two-fifths of the wives and one-third of the husband reported that their partner had children from at least one previous relationship. On average, the respondents themselves had had 3-5 children. At the time of the interview, almost one-fifths of the wives were pregnant. Child mortality was distressingly common. Half of the women and three-fifths of the men already had had at least one of their children die. The level of illiteracy among the population is also very high, with only one-third of the men and one-eighth of the women able to read easily a simple sentence in Chichewa, Malawi's national language.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Quality of Care: An Assessment of Family Planning Providers' attitudes and Client-Provider Interactions in Malawi.

• Describes the quality of clients-provider interactions in Malawi; Ascertain and describe the typology of attitudes among FP service providers; estimate the prevalence of these various attitudes appear to have on clients' initiation of modern contraceptive use, continuation of use, choice of method, age at initiation of use and parity at initiation of use. The study was conducted in all the three regions of Malawi. Eight districts were involved in some facet of the study. However, only one district from each region was selected for the intensive study. These were Zomba, for the southern region, Dowa for the Central and Rumphi for the northern region. Randomly, four more districts for focus group discussions with FP providers: Machinga, Ntcheu, Nkhotakota and Nkhata-bay, were selected. The intent of this study was to ascertain, describe, and quantify the attitudes of family planning providers and the quality of client provider interactions in Malawi. Because attitudes and quality of care issues are difficult to evaluate, a variety of methodologies: quantitative, qualitative and participatory were used. The study identified some beliefs that seem to underlie the negative attitudes among some FP providers. Some providers suspect that access to family planning is not beneficial for everyone of reproductive age, because, they think it can spread HIV/AIDS, increase immorality in society, could lead to infertility and/or promiscuity. The study discovered that a significant subset of providers had serious misgiving about contraceptives, and that the quality of care in Malawi FP clinics was acceptable about half the time. All the providers felt that their attitudes had some effect on clients, with the following breakdown: Large (61%), medium (8%) and small (31%). In contrast, only 6 in 10 districts personnel thought the attitudes of FP providers affected the contraceptive prevalence rate in their districts.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

Family Planning Knowledge, Attitudes and Practices: Machinga District.

• The sampling frame for the survey consisted of 11 (eleven) villages in the project catchment area, along with 11 (eleven) villages chosen to serve as the comparison area. A week before the survey, enumerators carried out a complete household listing for each village. For the KAP survey, data was collected through questionnaires. There were two separate questionnaires, one for women and another for men. Both questionnaires incorporated questions from the Malawi Demographic and Health Survey. The questionnaires were pretested in two villages of eastern Machinga. The survey was conducted in two weeks, immediately upon completion of the listings. The ages of the women in the sample are evenly spread between 15-45, with a concentration in the ages from 20-29. For men, the ages spread was between 19-49, with a concentration between ages 40-45. It was found that despite the older ages of men in the sample, 15% had never been married, as compared with only 4% of the women. This indicates that women in TA Kalembo marry at a considerably younger age than men. Regarding education and literacy, 74% of women sampled had never been to school as compared to 44% of men. Only 1% and 3% of women and men respectively, had attended secondary school or beyond. In the sample, 64% of the women as compared with 52% of the men, were long-term village residents. All the men interviewed were heads of their households, except in the case of unmarried men still living with their parents. More than one-fifth of the women were living in female-headed households. Women in Nandumbo were significantly less literate than those in Tsanya village. As a result of arranged marriages practices, 24% of respondents in Tsanya area knew their spouse before marriage; in Nandumbo, merely 15% did. 12% of Tsanga respondents were polygamous at the time of the interview and 22% in Nandumbo.

Location: CSR, Centre for Social Research, box 278, Zomba, Malawi. Email;csr@malawi.net, csr@sdnp.org.mw, csrbasis@malawi.net

125 Van den Broek, N.R; Letsky, E.A

The Aetiology of Anaemia in Pregnancy in Southern Malawi

• Examines aetiological factors responsible for anaemia in pregnant women in Blantyre. A cross-sectional descriptive study examining aetiological factors responsible for anaemia ([HbD,10.5g/di) in 150 pregnant women in Blantyre was undertaken. Iron, folate, vitamin B12 and vitamin A status were assessed by measurement in serum. In 88 cases appropriately stained bone marrow aspirates were available for evaluation. A peripheral blood film was examined for malaria parasites as were stool and urine for helminthic infection. Tests for genetic disorders including hemoglobinopathies and G6PD deficiency and for infection with the Human Immunodeficiency virus were done. (HM. C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were determined as markers of inflamation. Of the 150 anaemic women, 34 (23% were iron deficient with no evidence of any other nutritional deficiency, 49 (33%) women were iron deficient as well as deficient in one or more other nutrients, 39 (26%) were not iron deficient but did have evidence of another nutritional deficiency which was most commonly Vitamin A. 19% (28/150) of women with anaemia had no demonstrable nutritional deficiency. In over half these cases CRP was significantly raised suggesting associated chronic inflamation.

126 Van den Broek,NR;Mtonya,C;White,SA;Molyneux,ME.

Roductive Health in Southern Malawi: A Community-Based Survey.

• Assesses reproductive health problems in a rural community in Southern Malawi. A survey assessing reproductive health problems in a rural community was conducted in South Malawi. A total of 21,000 households were visited by locally trained women . Data were collected by using a structured questionnaire to document household composition, level of education and reproductive health problems as reported by the senior woman of the household. The total population surveyed was 69,247. Almost 40% of households were single female headed. Information was obtained on fertility rate (152/1000) women 15-44 years), pregnancy outcome, infertility and maternal mortality. Modern contraceptives were used by 10.6% of women who had delivered in the past 12 months (n=2168), antenatal care received, place of delivery and type of supervision was assessed and related to outcome (live baby or not). For women pregnant at the time of the survey (n=906), reported complaints and antenatal attendance were recorded. The influence of both level of education and distance from the nearest facility on antenatal clinic attendance, contraceptive uptake and pregnancy outcome were analysed.

An Evaluation of the effects of intermittent sulfadoxine-pyrimethamine treatment in pregnancy on parasite clearance and risk of low birthweight in rural Malawi.

• Investigates the prevalence of infection with malarial parasites and the incidence of anaemia and delivery of infants with low birthweight (LBW). 575 Malawian mothers who received one, 2 or 3 doses of sulfadoxine-pyrimethamine (SP) during pregnancy. All the subjects were enrolled at their first antenatal visit and all delivered at hospital.The prevalence of malaria infection (approximately 99% Plasmodium falciparum and remainder P. malariae) at the first antenatal visit was 35.5% in primagravidae than in multigravidae (P<0.001). The mean haemoglobin concentration was significantly lower in primagravidae than in multigravidae (8.8 vs 9.5g/dl; P<0.001). Of the 233 women tested for HIV infection, 18.8% of the primagravidae and 23.7% of the multigravidae were seropositive. At delivery, there was no significant difference in parasite prevalence in peripheral or placental blood between women who have received one or 2 antenatal doses of SP. The multigravidae who had received 2 doses of SP had higher mean haemoglobin concentrations than those who had received just one (P=0.009) (this difference was not seen in primigravidae). However, linear regression analysis indicated that the haematinic supplements given to the subjects contributed more to this increase in haemoglobin concentration than the SP.

Location: COM, College of Medicine, Private bag 360, Chichiri, Blantyre 3. Tel: 265-677 245/291, Fax: 674 700-33, com@malawi.net

Family Planning, STD, HIV/AIDS Programmes in the Private Sector: Overview of Case Studies and Strategy Framework.

• The purpose of the study was to document experiences and lessons in planning, developing and implementing FP,STD, HIV and AIDS programmes in the private sector; to formulate a strategy framework to guide companies in planning or replanning the institulization of FP, STD, HIV and AIDS programmes in their company activities, and to obtain feedback from the private sector about the feasibility and practability of the strategy framework. The findings of the study show that all the three companies have health policies that cover all employees and their families and that all have large workforce including permanent staff and casual employees who are hired temporarily during peak seasons. All the companies provide health services through company clinics. All their clinics are financed by the companies that provide drugs, supplies and equipment. Their family planning services are extended to neighbouring communities. Their activities also include peer education, community-based distribution of contraceptives and counselling for STD and HIV/AIDS patients and their families. Their activities are at different levels of advancement, with ADMARC leading in terms of the size of their programme out-reach and the size of their clinics and staff. Press Agriculture has the youngest and smallest programme.

An Impact Evaluation of Peer Education Programme for Bargirls and Track drivers Supported by the EC in Malawi.

• The research was conducted to determine the effect that peer education has on two of the target groups over the past five years; to determine whether it is possible to do an impact evaluation in a peer education programme run on a national level; to gather information that would assist in the planning of future interventions for the selected target groups. Six districts were randomly picked from South and Central Regions. The districts were chosen as two active, i.e training of peer educators had taken place within the last year and two non-active ones. All bars in the district were listed, assigned a number and selected randomly. Ten girls from each district were picked to participate in a focus group discussion. During these discussions, a tape recorder was used and field notes taken. A standard questionnaire, which was translated into Chichewa was used. The questionnaire was pre-tested in a non-survey district. Four hundred and twenty-four women were interviewed in all the six districts. Findings from the bargirls component showed a significant difference between districts with 40% of girls in the active group having heard of HIV/AIDS from a peer educator as opposed to 23.6% in the average areas and 27.5% in the non-active group. (X² = 18.9 P =<.001). The active area also scored higher with condom distribution from peer educators - 40.6% had received condoms from a peer educator in the active area while 19.3% had in the random group, and 15.6% in the non-active (X² = 27.5, P=<.001). Condom use with a paying partner within the last week was 90.3% in the active districts (X² = 10.02, P=<.01). In the track driver component, the results were not as positive but there was a significant difference when it came to condom distribution in the companies (X² =51.0, P = <.001).

Location: UNICEF/MOHP, Ministry of Health, P.O. BOX 30377, LILONGWE 3, Tel: 789 400, Fax: 773 431-33, email:registry.Malawi@undp.org, P.O. BOX 30375, LILONGWE 3[New Commercial Bank Building, 2^nd Floor, Capital City], Tel: 770 304/770 770/770 788, Fax: 773 162, email:unicef@unima.wn.apc.org or unicerf@malawi.net

Maternal Mortality at Queen Elizabeth Central Hospital: 1989 to 1990

• The purpose of the study was to determine causes of death, analyse avoidable factors and look for ways to reduce mortality. Records of all maternal deaths at the Chatinkha Maternity Wing of QECH in 1989 and 1990 were reviewed. The files of 1990 were complete. In 1989 several records were missing and the information was then obtained from death books and nursing records kept on each ward. Death files of the female medical and surgical wards were scanned for patients with a pregnancy reported at the time of death or during the preceding 42 days. In 1990 files were completed immediately after the patient's death and missing laboratory and other test reports collected. In 1989 there were 78 maternal deaths, including 10 on the medical and surgical wards, for 14,272 live births, or a maternal mortality ratio of 546. In 1990 there were 73 deaths, also including 10 from other wards, and 14,281 live births, or 511 maternal deaths per 100,000 live births. In each year there were 37, with the leading two causes in 1990 the reverse of those in 1989. In order to find an explanation for the significant increase in deaths from puerperal sepsis in 1990, these cases were reviewed in greater detail. Of the 13 patients 2 delivered at home, 4 at QECH, while 7 were referred from 6 different district hospitals one to 8 weeks after delivery. Despite a time interval of more than 42 days between delivery and death in 4 cases all were included, because of the presumed link between death and pregnancy. Of the two patients who had home deliveries, one was admitted with peritonitis and symptoms of HIV infection. She was severely wasted, had generalized lymphadenopathy and was HIV+. She died shortly before a scheduled laparotomy. The second patient proved to have a ruptured tubo-ovarian abscess, one week post partum. She underwent two laparotomies, but eventually died of septicaemia.

A KAPB Study to establish Baseline data in Targeted Groups of selected Districts of Malawi for Future HIV Prevention Campaigns: Survey Report

• The aim of the survey was to establish baseline indicators to evaluate the impact of IEC interventions in the selected high risk groups on STD/HIV transmission and to generate vital information for designing and implementing educational programmes. The survey was conducted in Dedza, Dowa, Mchinji, Ntcheu, Blantyre and Lilongwe. It involved bar girls and truck drivers constituting 747 respondents. Data for this survey were collected through a semi-structured questionnaire which was administered by the interviewers. The results showed that more than 70% of the girls and the STD patients were less than 30 years old. In contrast, 84% of truck drivers were more than 30 years old. More than 50% of the respondents mentioned AIDS spontaneously as a serious health problem. The majority (82%) knew that AIDS could be prevented. The method most mentioned (62%) was avoiding sex with multiple partners.

Location: UNICEF, P.O. BOX 30375, LILONGWE 3[New Commercial Bank Building, 2^nd Floor, Capital City], Tel: 770 304/770 770/770 788, Fax: 773 162, email:unicef@unima.wn.apc.org or unicerf@malawi.net

The Effectiveness of Weekly Iron Supplementation in Pregnant Rural Women of Northern Malawi.

• The main objective of this study was to compare the effectiveness of a weekly iron supplement in pregnant women of Northern Malawi to the standard daily supplement. Women were enrolled as they attended the local antenatal clinic, stratified by grade of anaemia and then randomized to receive either 60mg iron/.25mg folate per day (n=211) or 120mg iron/.50mg folate once per week (n=202). Supplementation was continued for a minimum of 8 weeks (10 weeks on average) and was self administered by the women at home. Initial haemoglobin values for the daily (u105.7g/L and weekly (u104.4g/L) groups as well as final haemoglobin values (107.5g/L and 105.6g/L respectively) did not differ significantly between the two groups. Haemoglobin values increased by similar levels in both groups with the subset of anaemic women increasing by an average of 6.3g/L in the daily group (n=70) and 5.9g/L in the weekly group (n=66). Compliance, as indicated by self reporting and by regular counts of remaining tablets was significantly higher in the weekly group (76% compared to 60%,p<0.05>), however compliance was identical in both groups when assessed by a stool test for elemental iron. Reported side effects were significantly reduced in the weekly group (6% compared to 17%,p<0.05). A weekly iron supplement given to pregnant women in rural Malawi has similar haematologic effects, and an improved side effect profile, in comparison to a standard daily supplement when administered through an existing primary health care programme.

A Randomised Trial on the Haematologic Effects of Daily Versus Weekly Iron Supplementation in Students Attending the Ekwendeni Girls Secondary School.

• This research was carried out in order to compare the effectiveness of a weekly iron supplement in secondary school age girls of northern Malawi to the standard daily supplement. Students who were enrolled had a check of initial haemoglobin concentration, then were stratified by grade of anaemia and randomized to receive either 60mg iron/.25mg folate per day (n=154) or 120m iron/.50 mg folate once per week (n=151). Supplementation was continued for a period of 8 weeks and was self-administered by the students. Initial haemoglobin values for the daily (u 133g/L) and weekly (u=136g/L) groups as well as final haemoglobin values (u=136g/L) and 136g/L respectively did not differ significantly between the two groups. Very little change in haemoglobin concentration was found in either group after 8 weeks, when all subjects were analyze together. However, students in both Forms 3 and 4 showed significant haemoglobin increases, averaging 4.5.g/L for the compliance, as indicated by self reporting and by regular counts of remaining tablets, was higher in the weekly group (67% compared to 58%).Reported side effects we significantly reduced in the weekly group (11% compared to 20%,p=0.596). A weekly iron supplement given to secondary school age girls in rural Malawi has similar haemotologic effects and an improved side effect profile, in comparison to a standard daily supplement and that students in the two upper Forms (3 & 4) would benefit most from a supplementation programme.

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