INTRODUCTION GEOGRAPHY, HISTORY, AND THE ECONOMY. Louis M. Magombo GEOGRAPHY

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1 INTRODUCTION 1 Louis M. Magombo 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY GEOGRAPHY Malawi is a landlocked country south of the equator in sub-saharan Africa. It is bordered to the north and northeast by the United Republic of Tanzania; to the east, south, and southwest by the People s Republic of Mozambique; and to the west and northwest by the Republic of Zambia. The country is 901 kilometres long and ranges in width from 80 to 161 kilometres. It has a total area of 118,484 square kilometres of which 94,276 square kilometres is land area. The remaining area is mostly composed of Lake Malawi, which is about 475 kilometres long and runs down Malawi s eastern boundary with Mozambique. Malawi s most striking topographic feature is the Rift Valley that runs the entire length of the country, passing through Lake Malawi in the Northern and Central regions to the Shire Valley in the south. The Shire River drains the water from Lake Malawi into the Zambezi River in Mozambique. To the west and south of Lake Malawi lie fertile plains and mountain ranges whose peaks range from 1,700 to 3,000 metres above sea level. The country is divided into three regions: the Northern, Central, and Southern regions. There are 27 districts in the country. Six districts are in the Northern Region, nine are in the Central Region, and 12 are in the Southern Region. Administratively, the districts are subdivided into Traditional Authorities (TAs), presided over by chiefs. Traditional Authorities are composed of villages, which are the smallest administrative units and are presided over by village headmen. Malawi has a tropical, continental climate with maritime influences. Rainfall and temperature vary depending on altitude and proximity to the lake. From May to August, the weather is cool and dry. From September to November, the weather becomes hot. The rainy season begins in October or November and continues until April. HISTORY Malawi was under British rule from 1891 until July 1964 under the name of the Nyasaland Protectorate. In 1953, the Federation of Rhodesia and Nyasaland was created, which was composed of three countries, namely, Zimbabwe (then Southern Rhodesia), Zambia (then Northern Rhodesia) and Malawi (then Nyasaland). In July1964, the country became the independent state of Malawi, and it gained republic status in In 1994, the country became a multiparty state and adopted a strategy to eradicate poverty. Since then the following have been introduced: free primary school education, a free market economy, a bill of rights, and a parliament with three main parties. Over the past ten years, the country has experienced a considerable increase of migrants from rural to urban areas. Introduction * 1

2 ECONOMY Malawi has a predominantly agricultural economy. Agricultural produce accounted for 61 percent of Malawi s exports in 1999: tobacco, tea, and sugar being the major export commodities. The country is largely self-sufficient for food. 1.2 POPULATION The major source of historical demographic data comes from the population censuses. Population censuses have been taken in Malawi during the years 1891, 1901, 1911, 1921, 1926, 1931, 1945, 1956, 1966, 1977, 1987, and Other sources of population data include nationwide surveys: 1968/69, 1980/81, and 1992/93 National Sample Surveys of Agriculture; the Malawi Population Change Survey; the 1982 Malawi Demographic Survey; the 1983 Malawi Labour Force Survey and Survey of Handicapped Persons; the 1984 Family Formation Survey; the 1992 Malawi Demographic and Health Survey (MDHS); the 1996 Malawi Knowledge, Attitudes, and Practises in Health Survey (MKAPH); and the 1997/98 Integrated Household Survey. Table 1.1 provides some demographic indicators for Malawi based on the previous three censuses. Table 1.1 Demographic indicators Selected demographic indicators, Malawi, 1977, 1987 and 1998 national censuses Census year Index Population 5,547,460 7,988,507 9,933,868 Intercensal growth rate Total area (sq km) Land area (sq km) Density (population per sq km) Percentage of urban population Women of child bearing age as a percentage of female population Sex ratio Crude birth rate Total fertility rate Crude death rate Infant mortality rate Life expectancy: Male Female , , ,484 94,276 94,276 94, The 1998 Population and Housing Census enumerated a total population of 9.9 million. The population grew from 8.0 million in 1987 representing an increase of 24 percent or an intercensal population growth rate of 2.0 percent per year. Along with population growth has come increasing 2 * Introduction

3 population density from 85 persons per square kilometre in 1987 to 105 persons per square kilometre in To address problems associated with rapid population growth, the Malawi government adopted a National Population Policy in 1994, which was designed to reduce population growth to a level compatible with Malawi s social and economic goals (OPC, 1994). The policy s objectives include the following: to improve family planning and health care programmes, to increase school enrolment with an emphasis on raising the proportion of female students to 50 percent of total enrolment, and to increase employment opportunities particularly in the private sector. 1.3 OBJECTIVES OF THE SURVEY 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. Introduction * 3

4 1.4 ORGANISATION OF THE SURVEY The 2000 MDHS survey was a comprehensive survey that involved several agencies. The National Statistical Office (NSO) had the major responsibility for conducting the survey. The Ministry of Health and Population, the National AIDS Secretariat, the National Economic Council, and the Ministry of Gender also contributed to the development of the questionnaires for the survey. Financial support for the survey was provided by the United States Agency for International Development (USAID), the United Kingdom s Department for International Development (DfID), and the United Nations Children s Fund (UNICEF/Malawi). Technical assistance was provided by Macro International Inc., USAID-funded MEASURE DHS+ project (USA). 1.5 SAMPLE DESIGN The 2000 MDHS survey was designed to provide estimates of health and demographic indicators at the national and regional levels, for rural and urban areas, and for some districts that were designated for oversampling. The 2000 MDHS sample points (clusters) were systematically sampled from a list of enumeration areas (EAs) defined in the 1998 Malawi Census of Population and Housing. A total of 560 clusters were drawn from the census sample frame: 449 in rural areas and 111 in urban areas. Eleven districts were oversampled in the 2000 MDHS survey in order to produce reliable estimates for certain variables at the district level. The oversampled districts are: Lilongwe, Blantyre, Zomba, Mzimba, Mangochi, Kasungu, Salima, Machinga, Mulanje, Thyolo, and Karonga. Upon selecting the 560 clusters, NSO trained teams of personnel in MDHS procedures for the comprehensive listing of households and updating of maps in the selected clusters. Nine listing teams were deployed; each team was composed of ten members including a team leader and driver. Each team was provided with a Global Positioning System (GPS) unit to obtain geographic coordinates for the locality of each selected cluster. The listing of households was conducted from early April until early May After the listing operation was complete, households to be included in the MDHS survey were selected, with the number of households selected per cluster being inversely proportional to the size of the cluster. Within each selected household, all women age were eligible for interview. Further, a one-in-four systematic subsample of households was drawn, within which all men age were eligible for interview. 1.6 QUESTIONNAIRES Three types of questionnaires were used in the 2000 MDHS survey: the Household Questionnaire, the Women s Questionnaire, and the Men s Questionnaire. The contents of the questionnaires were based on the MEASURE DHS+ model. A series of meetings were held with policy experts, programme managers, and other professionals in Malawi to review, adapt, and revise the questionnaires. This process culminated in English-version questionnaires that were then translated into Chichewa and Tumbuka. 4 * Introduction

5 The Household Questionnaire was used to list all of the usual members and visitors in the selected households 1. Basic information on each person listed was collected, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify all of the eligible women (age 15-49) and men (age 15-54) for individual interviews. In addition, information was collected about characteristics of the household, such as the source of water, type of toilet facilities, materials used to construct the household s dwelling, and ownership of various consumer goods. Data on child labour practises, use of bednets (mosquito nets), and nutritional status of children and women were also collected in the Household Questionnaire. The Women s Questionnaire was used to collect information from women age and included questions on the following topics: Background characteristics (age, education, religion, etc.) Reproductive history (to arrive at fertility and childhood mortality rates) Knowledge and use of family planning methods Antenatal and delivery care Infant feeding practises, including patterns of breastfeeding Childhood vaccinations Recent episodes of childhood illness and responses to illness, especially recent fevers Marriage and sexual activity Fertility preferences Woman s status and decisionmaking Mortality of adults, including maternal mortality AIDS-related knowledge, attitudes, and behaviour The Men s Questionnaire covered many of the same topics but excluded the detailed reproductive history and sections dealing with maternal and child health and adult and maternal mortality. The Men s questionnaire is consequently much shorter than the Women s Questionnaire. The questionnaires were pretested in February 2000 in Mzimba, Ntcheu, and Blantyre City. More than 200 interviews were conducted over a one-week period. The questionnaires were produced in three language versions: Chichewa, Tumbuka, and English. However, interviews could be conducted in any of the languages spoken in Malawi if the respondent was not fluent in one of these three languages. Adjustments in language and content were made to the questionnaires based on the lessons drawn from the pretest interviews. 1.7 TRAINING Training of field staff for the main survey was conducted over a three-week period in June and July The training took place at Chilema Ecumenical Lay Training Centre outside Zomba Municipality. A total of 200 field staff were trained. The training course consisted of instruction in general interviewing techniques, and field procedures, a detailed review of items on the questionnaires, instruction and practise in weighing and measuring children and women, mock interviews between participants, and practical interviews 1 A household is defined as one or more persons, related or unrelated, who live together, make common provisions for food, regularly take their food from the same pot or same grainstore (Nkhokwe), or pool their income for the purpose of purchasing food. Introduction * 5

6 in surrounding villages. In-depth discussions of the translations were an important part of the training programme. The trainees included 26 medically trained personnel who worked on the survey as health technicians. Of the trainees, 183 who performed satisfactorily in the training programme were selected to form the 22 teams for the fieldwork. The rest, if qualified, were employed as MDHS data entry and registry staff. 1.8 DATA COLLECTION AND DATA PROCESSING Twenty-two interviewing teams carried out the fieldwork for the MDHS survey, with each team consisting of one team leader, one field editor, four female interviewers, one health technician, one male interviewer, and one driver. On a few teams, an additional male interviewer was added. Additionally, six senior staff from NSO coordinated and supervised field activities. Data collection began on July 12 and was completed in early November Complete, field-edited questionnaires were brought to the NSO headquarters in Zomba after collection during supervisory visits by NSO senior staff. Data entry began one week after data collection started and was completed in December Office editing, coding of open-ended questions, and editing based on computer identified inconsistencies in the data continued into January The questionnaires were entered, verified, and edited using a new version of ISSA (Integrated System for Survey Analysis) adapted by ORC Macro and the U.S. Bureau of Census for integrated use in censuses and surveys. Table 1.2 shows the results of household and individual interviews for Malawi as a whole, and for urban and rural areas. A total of 15,421 households were selected in the MDHS sample, of which 14,352 were occupied. Of the occupied households, 14,213 were interviewed, yielding a household response rate of 99 percent. The household response rate was slightly higher in rural areas. Table 1.2 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Malawi 2000 Residence Result Urban Rural Total Household interviews Households sampled Households occupied Households interviewed 2,868 2,714 2,680 12,553 11,638 11,533 15,421 14,352 14,213 Household response rate Individual interviews: women Number of eligible women Number of eligible women interviewed 2,929 2,871 10,609 10,349 13,538 13,220 Eligible woman response rate Individual interviews: men Number of eligible men Number of eligible men interviewed ,566 2,371 3,377 3,092 Eligible man response rate * Introduction

7 Within the interviewed households, 13,538 eligible women age were identified, of which 13,220 were interviewed. The individual women s response rate to the 2000 MDHS survey was 98 percent. In the one-in-four subsample of households, 3,377 men age were identified, of which 3,092 men were interviewed, giving a response rate of 92 percent. The main reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. It is typical for male response rates to be lower than female response rates because men are more frequently absent from the household. Response rates for women were not influenced by urban-rural residence, but men s response rates were significantly better in rural areas than in urban areas. In comparing response rates from the 1992 MDHS survey and the 2000 MDHS survey, the more recent survey performed slightly better. The women s response rate rose from 97 to 98 percent, and the men s response rate increased from 89 to 92 percent. Introduction * 7