The 2000 Malawi Demographic and Health Survey (MDHS) is a nationally representative sample survey covering 14,213 households, 13,220 women age 15-49, and 3,092 men age 15-54. The 2000 MDHS is similar, but much expanded in size and scope, to the 1992 MDHS. The survey was designed to provide information on fertility trends, family planning knowledge and use, early childhood mortality, various indicators of maternal and child health and nutrition, HIV/AIDS, adult and maternal mortality, and malaria control programme indicators. Unlike earlier surveys in Malawi, the 2000 MDHS sample was sufficiently large to allow for estimates of certain indicators to be produced for 11 districts in addition to estimates for national, regional, and urban-rural domains. Twenty-two mobile survey teams, trained and supervised by the National Statistical Office, conducted the survey from July to November 2000.
The principal aim of the 2000 MDHS project is to provide up-to-date information on fertility and childhood mortality levels, nuptiality, fertility preferences, awareness and use of family planning methods, use of maternal and child health services, and knowledge and behaviours related to HIV/AIDS and other sexually transmitted infections. It was designed as a follow-on to the 1992 MDHS survey, a national-level survey of similar scope. The 2000 MDHS survey also strived to collect data that would be comparable to those collected under the international Multiple Indicator Cluster Survey (MICS), sponsored by UNICEF.
In broad terms, the 2000 MDHS survey aimed to :
- Assess trends in Malawi's demographic indicators-principally, fertility and mortality
- Assist in the evaluation of Malawi's health, population, and nutrition programmes
- Advance survey methodology in Malawi and contribute to national and international databases. In more specific terms, the 2000 MDHS survey was designed to provide data on the family planning and fertility behaviour of the Malawian population and to thereby enable policymakers to evaluate and enhance family planning initiatives in the country.
- Measure changes in fertility and contraceptive prevalence and at the same time, study the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding habits, and important social and economic factors.
- Examine basic indicators of maternal and child health and welfare in Malawi, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and use of immunisation services. A particular emphasis was placed on the area of malaria programmes, including prevention activities and treatment of episodes of fever.
- Describe levels and patterns of knowledge and behaviour related to the prevention of HIV/AIDS and other sexually transmitted infections.
- Measure the level of adult and maternal mortality at the national level.
- Assess the status of women in the country.
SUMMARY OF FINDINGS
- FERTILITY Fertility Decline. The 2000 MDHS data indicate that there has been a modest decline in fertility since the 1992 MDHS. Large Fertility Differentials. Fertility levels remain high in Malawi, especially in rural parts of the country. The total fertility rate among rural women is 6.7 births per woman compared with 4.5 births in urban areas. Childbearing at Young Ages. One-third of adolescent females (age 15-19) have either already had a child or are currently pregnant.
- FAMILY PLANNING Increasing Use of Contraception. A principle cause of the fertility decline in Malawi is the steady increase in contraceptive use over the last decade.
Changing Method Mix. Currently, the most widely used methods among married women are injectable contraceptives (16 percent), female sterilisation (5 percent), and the pill (3 percent). Source of Family Planning Methods. The survey results show that government-run facilities remain the major source for contraceptives in Malawi-providing family planning methods to 68 percent of the current users.
- CHILD HEALTH AND SURVIVAL Progress in Reducing Early Childhood Mortality. The 2000 MDHS data indicate that mortality of children under age 5 has declined since the early 1990s.
Childhood Vaccination Coverage Declines. The 2000 MDHS results show that 70 percent of children age 12-23 months are fully vaccinated.
Improved Breastfeeding Practices. The 2000 MDHS results show that exclusive breast-feeding of children under 4 months of age has increased to 63 percent from only 3 percent in the 1992 MDHS. Nutritional Status of Children. The results show no appreciable change in the nutritional status of children in Malawi since 1992; still, nearly half (49 percent) of the children under age five are chronically malnourished or stunted in their growth.
- MALARIA CONTROL PROGRAMME INDICATORS Bednets. The use of insecticide-treated bednets (mosquito nets) is a primary health intervention proven to reduce malaria transmission.
Treatment of Fever in Children Under Age Five. The survey found that 42 percent of children under age five had a fever in the two weeks preceding the survey.
- WOMEN'S HEALTH Maternal Health Care. The survey findings indicate that use of antenatal services remains high in Malawi. Constraints to Use of Health Services. Women in the 2000 MDHS were asked whether certain circumstances constrain their access to and use of health services for themselves.
Rising Maternal Mortality. The survey collected data allowing measurement of maternal mortality. For the period 1994-2000, the maternal mortality ratio was estimated at 1,120 maternal deaths per 100,000 live births. This represents a rise from 620 maternal deaths per 100,000 estimated from the 1992 MDHS for the period 1986-1992.
- HIV/AIDS Impact of the Epidemic on Adult Mortality. All-cause mortality has risen by 76 percent among men and 74 percent among women age 15-49 during the 1990s. The age patterns of the increase are consistent with causes related to HIV/AIDS.
Improved Knowledge of AIDS Prevention Methods. The 2000 MDHS results indicate that practical AIDS prevention knowledge has improved since the 1996 MKAPH survey.
Condom Use. One of the main objectives of the National AIDS Control Programme is to encourage consistent and correct use of condoms, especially in high-risk sexual encounters. The
HIV-testing Experience. The 2000 MDHS data show that 9 percent of women and 15 percent of men have been tested for HIV. However, more than 70 percent of both men and women, while not yet tested, said that they would like to be tested.